Surgical instruments, systems and methods of use

ABSTRACT

A surgical instrument includes a mount body, a joint member, an arm, and a working end. The mount body has a top portion, a distal end, a proximal end and a bottom portion. The joint member is pivotally mounted at a distal end portion of the mount body, to allow positioning of a proximal portion of an arm extending distally from the joint member. The joint member is also configured to at least partially constrain movement of the proximal portion of the arm to a plane. The working end is mounted to a distal end portion of the arm. The surgical instrument can be configured as a heart stabilizer or a heart positioner. The joint member may further be configured as a slotted ball, a disk member, or a combination thereof.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 61/354,516, entitled “Surgical Instruments, Systems and Methodsof Use” which was filed on Jun. 14, 2010, the content of which areincorporated herein by reference in its entirety.

FIELD OF THE INVENTION

The present invention relates generally to surgical instruments, andmore particularly to surgical instruments useful for engaging surfacesof an organ, including organ stabilizer instruments and organ positionerinstruments and their related components.

BACKGROUND OF THE INVENTION

Diseases of the cardiovascular system affect millions of people eachyear and are a leading cause of death throughout the world. The cost tosociety from such diseases is enormous both in terms of the number oflives lost as well as in terms of the costs associated with treatingpatients through traditional surgical techniques. A particularlyprevalent form of cardiovascular disease is a reduction in the bloodsupply leading to the heart caused by atherosclerosis or other conditionthat creates a restriction in blood flow at a critical point in thevasculature supplying blood to the heart.

One option for treatment of such a blockage or restriction in the bloodflow supplying the heart is a procedure known as a coronary arterybypass graft (CABG) surgery, more commonly known as a “heart bypass”operation. In the CABG procedure, the surgeon “bypasses” the obstructionto restore adequate blood flow to the heart either by attaching anavailable source vessel to the obstructed target coronary artery or byremoving a portion of a vein or artery from another part of the body, touse as a graft, and installing the graft between a point on a sourcevessel and a point on a target artery.

To restore an adequate supply of blood to the heart, the CABG procedurerequires that a fluid connection be established between two vessels.This procedure is known as an “anastomosis.” Typically, a source vessel,such as a source artery with an unobstructed blood flow, i.e., the leftor right internal mammary artery (IMA), or a bypass-graft having one endsewn to an unobstructed blood source such as the aorta, is sewn to atarget occluded coronary artery, such as the left anterior descending(LAD) artery or other vessel that provides blood flow to the muscles ofthe heart.

Although the CABG procedure has become relatively common, the procedureitself is lengthy and traumatic and can damage the heart, thecardiovascular system, the brain, and the blood cells, as well asactivate plasma cascade systems. In a conventional CABG procedure, thesurgeon makes an incision down the center of the chest, cuts through thesternum, performs several other procedures necessary to attach thepatient to a heart-lung bypass machine, cuts off the blood flow to theheart and then stops the heart from beating in order to complete thebypass. The most lengthy and traumatic surgical procedures arenecessary, in part, to connect the patient to a cardiopulmonary bypass(CPB) machine to continue the circulation of oxygenated blood to therest of the body while the bypass is completed.

In recent years, a growing number of surgeons have begun performing

CABG procedures using surgical techniques especially developed so thatthe CABG procedure could be performed while the heart is still beating.In such procedures, there is no need for any form of cardiopulmonarybypass, and no need to stop the heart. As a result, these beating heartprocedures are much less invasive and carry lower risk of post-operativeneurological complications. In certain situations, the entirebeating-heart CABG procedure can be performed through a small number,typically one or two, of comparatively small incisions in the chest,further reducing the risk of post-operative wound complications.

When CABG procedures are performed on a beating heart, a surgicalstabilizer instrument is typically used to stabilize the heart tissue inthe area of the anastomosis. Various surgical stabilizer instruments areavailable today. Typically the surgical stabilizer instrument will havesome form of attachment mechanism that permits it to be fixed to thesternal retractor, so that it is maintained fixed relative to the tissueto be stabilized. One drawback of currently available stabilizerinstruments is that they tend to extend too far across the open chestcavity and may obstruct movements of the surgeon's hands in someinstances. Additionally, the arm and attachment mechanism also extendabove the surface of the retractor and may also form an obstruction.

There is a continuing need for surgical stabilizer instruments having alower profile and that can be extended into the chest cavity in aconfiguration that causes less obstruction to the operating surgeon.

When an anastomosis is to be performed on a surgical target area that isnot readily accessible by the surgeon (e.g., one or more arteries ofinterest are located on the lateral or posterior aspects of the heart,making access to such arteries difficult), the heart is typicallyrepositioned either by hand, by the surgeon or a surgeon's assistant,or, more commonly, by attachment of an organ positioner instrument tothe heart, for repositioning and maintaining the heart in a displacedposition via the organ positioner instrument.

Various organ positioner instruments are available today. Typically theorgan positioner will have some form of attachment mechanism thatpermits it to be fixed to the sternal retractor, so that it is can besupported by the sternal retractor while it is maintaining the organ inthe displaced position.

One drawback of currently available organ positioner instruments, isthat they tend to extend too far across the open chest cavity and mayobstruct movements of the surgeon's hands in some instances, and mayprevent viewing of some areas in the surgical field.

There is a continuing need for organ positioner instruments that can beextended into the chest cavity in a configuration that causes lessobstruction to the operating surgeon.

The present invention meets these needs as well as providing additionalimproved features that will become apparent upon reading the detaileddescription below.

SUMMARY OF THE INVENTION

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body having a top portion, a distal end, aproximal end and a bottom portion; a joint member pivotally mounted at adistal end portion of the mount body to allow positioning of a proximalportion of an arm extending distally from the joint member, the jointmember configured to at least partially constrain movement of theproximal portion of the arm to a plane; and a working end mounted to adistal end portion of the arm.

According to an example embodiment, the joint member comprises a firstjoint member and a second joint member, wherein the first joint memberconfines movement of the proximal portion of the arm to yawing, and thesecond joint member confines movement of the proximal portion of the armto pitching.

According to an example embodiment, the joint member pivotally mountedat the distal end portion of the mount body is a disk member.

According to an example embodiment, the joint member further comprises aslotted ball.

According to an example embodiment, the joint member is a disk member,and the slotted ball is connected to said disk member.

According to an example embodiment, further comprising an actuatorrotatably mounted to the mount body towards the proximal end of themount body, and a cable extending from the actuator through the mountbody, joint member, slotted ball and arm, the actuator and the cablebeing configured to change a state of the arm from a flexible state to arigid state by movement of the actuator in a first direction, and fromthe rigid state to the flexible state by movement of the actuator is asecond direction opposite the first direction.

According to an example embodiment, movement of the actuator involvesrotation, the first direction is a first rotational direction, and thesecond direction is a counter-rotational direction.

According to an example embodiment, the slotted ball member forms ajoint with a proximal end of the arm.

According to an example embodiment, upper and lower surfaces of the diskmember extend substantially parallel with the top portion of the mountbody, and wherein the slotted ball is capable of pivoting to anangularly downward position from a plane parallel to the upper and lowersurfaces of the disk member.

According to an example embodiment, the instrument comprising a vacuumtube in fluid communication with the working end, and the working end isconfigured to reversibly attach to the exterior surface of a human'sheart.

According to an example embodiment, the instrument comprises an actuatorrotatably mounted to the mount body at the proximal end of the mountbody, the actuator being configured to change a state of the arm from aflexible state to a rigid state by rotation of the actuator in a firstrotational direction, and from the rigid state to the flexible state byrotation of the actuator in a counter-rotational direction.

According to an example embodiment, the instrument comprises a suctiontube in fluid communication with the working end, and a clip configuredto receive and temporarily hold the suction tube to maintain the suctiontube in a low profile with the instrument, wherein the clip is formedwith or connected to the mount body, the actuator, or both the mountbody and the actuator.

According to an example embodiment, the actuator comprises a pluralityof fins with one of the clips formed in one or more of the fins.

According to an example embodiment, the instrument is an organstabilizer and the working end comprises at least one contact memberconfigured to be exerted against a tissue surface to stabilize thetissue surface.

According to an example embodiment, the instrument is an organpositioner and the working end comprises a suction member defining avacuum space therein, wherein the suction member is configured toreceive the apex of a human heart.

According to an example embodiment, the instrument is further configuredto exert sufficient suction force on the heart to move the heart whenthe suction member is placed against the heart, a negative pressure of250 millimeters of Mercury is applied within the vacuum space to engagethe suction member with the heart, and the suction member is moved.

According to an example embodiment, the bottom portion comprises amounting mechanism configured to reversibly clamp the instrument to afixed object.

According to an example embodiment, the mounting mechanism is fixed to asurface of a sternal retractor, the sternal retractor comprising asternal retractor blade mounted to or integral with the sternalretractor, wherein the arm is capable of being oriented downwardly tomake contact with an inner surface of a sternal retractor blade withoutrequiring the movement of the actuator with respect to the mountingbody.

According to an example embodiment, the mounting mechanism comprises afixed jaw and a movable jaw; and wherein a mounting mechanism actuatoris pivotally mounted within the bottom portion and at least partiallyabove the movable jaw, the mounting mechanism actuator being configuredto move the movable jaw from an unlocked position to a locked positionand vice versa.

According to an example embodiment, the mounting mechanism actuator isconfigured to move the movable jaw toward the locked position when themounting mechanism actuator is pulled in a proximal direction.

According to an example embodiment, the mounting mechanism comprises afixed jaw that is unitarily formed with the main body, and a movable jawmovably engaged to the main body.

According to an example embodiment, the instrument comprises a cammounted above a bottom surface of the movable jaw and below the mountingmechanism actuator, the cam connected to the mounting mechanism actuatorto be actuated to lock or unlock the movable jaw.

According to an example embodiment, the mounting mechanism comprises amounting mechanism actuator, the mounting mechanism actuator includingrocker switches with cams configured to clamp to the fixed object.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members and a blower/misterdevice incorporated into at least one of the contact members.

According to an example embodiment, the instrument is a stabilizerconfigured for a blower/mister device to be attached thereto.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members and a support tolink the contact members to the arm, wherein the support is pivotallylinked to the contact members.

According to an example embodiment, the contact members each comprise aclip at a proximal end portion thereof, the clips configured to form asnap fit with the support members.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members, the contact memberseach having a relatively thicker cross-sectional dimension at an outsideedge thereof and a relatively thinner cross-sectional dimension at aninside edge thereof.

According to an example embodiment, the arm comprises an intermediatelink that is adjustable by a user to adjust a portion of the arm distalof the intermediate link and the working member to assume a flexibleconfiguration in a first configuration, and to assume a rigidconfiguration in a second configuration, while allowing a portion of thearm proximal of the intermediate link to remain flexible during both thefirst configuration and the second configuration.

According to an example embodiment, the arm comprises an intermediatelink that is adjustable by a user to adjust a portion of the armproximal of the intermediate link to assume a flexible configuration ina first configuration, and to assume a rigid configuration in a secondconfiguration, while allowing a portion of the arm distal of theintermediate link and the working end to remain flexible during both thefirst configuration and the second configuration.

According to an example embodiment, the instrument comprises a motorconfigured to operate the actuator, and a second actuator, locateddistally of the actuator and the motor, electrically connected to themotor, and configured to actuate the motor to drive the actuator toincrease or decrease rigidity in the arm and a connection between thearm and the working end.

According to an example embodiment, the top portion is smooth andcomprises a flat portion with no obstructions thereon, and wherein thetop surface provides a rest for a surgeon's hand, that can be used tohelp stabilize the surgeon's hand.

According to an example embodiment, ridges or teeth provided around atleast a portion of a perimeter of the disk member.

According to an example embodiment, the instrument a cable extendingthrough the disk member, at least a portion of the arm, and at least aportion of the mount body, wherein the disk member comprises a slotformed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, the disk member comprises a slotformed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, the instrument comprises an actuatorrotatably mounted to the mount body at the proximal end of the mountbody and a cable extending from the actuator through the mount body,disk member, slotted ball and arm, the actuator and the cable beingconfigured to change a state of the arm from a flexible state to a rigidstate by rotation of the actuator in a first rotational direction, andfrom the rigid state to the flexible state by rotation of the actuatorin a counter-rotational direction.

According to an example embodiment, the instrument comprises a canisterin fluid communication with the vacuum tube, the canister having anopening for connecting the canister in fluid communication with a vacuumsource, the canister configured to trap fluid therein.

According to an example embodiment, the instrument comprises a filter influid communication with the opening of the canister, the filterconfigured to be connected to the vacuum source and to filterparticulates from effluent from the canister.

According to an example embodiment, the canister has at least onesubstantially flat side.

According to an example embodiment, the instrument comprises a strapconnected to the canister and adapted to hang the canister in an uprightorientation wherein the opening for connecting the canister with avacuum source is higher than a connection forming the fluidcommunication of the canister with the vacuum tube.

According to an example embodiment, a surface of the canister is mattedto inhibit glare reflection therefrom.

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body, an arm, and a tool; the mount bodyconfigured to be used with a retractor, a bottom surface of the mountbody facing the retractor when mounted, a front edge of the mount bodyrunning at an angle to the bottom surface; the arm pivotally connectedon a proximal end thereof via the end joint to the front edge of themount body; the tool connected to a distal end of the arm; the armconfigured to be movable between a plurality of positions relative tothe mount body and to be temporarily lockable in these positions.

According to an example embodiment, the joint configured such that aproximal portion of the arm extending from or adjacent to the mount bodyis pivotable to the mount body and temporarily lockable in a positionsubstantially perpendicular to the mount body.

According to an example embodiment, the joint configured such that aproximal portion of the arm extending from and adjacent the mount bodyis movable from a left distal region of the mount body to a right distalregion of the mount body and vice versa.

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body, an arm, a tool and a tube; the mountbody configured to mount to a retractor or a surgical table; the armpivotally connected on a proximal end to the mount body; the toolconnected to a distal end of the arm; the arm configured to be movablebetween a plurality of positions relative to the mount body and to betemporarily lockable in these positions; a distal end of the tubeconnected at or adjacent a distal end of the arm; and the mount bodyconfigured to removably retain the tube.

According to an example embodiment, the mount body includes a recesssized to receive and removably retain the tube.

According to an example embodiment, the mount body includes a clip sizedto receive and removably retain the tube.

According to an example embodiment, the mount body further comprising anactuator rotatably mounted to the surgical instrument, the actuatorbeing configured to change a state of the arm form a flexible state to arigid state by rotation of the actuator in a first rotational direction,and from the rigid state to the flexible state by rotation of theactuator in a counter-rotational direction; and the actuator configuredto removably retain the tube.

An example method of operating a surgical instrument according to thepresent invention comprises the steps of attaching a mount body of theinstrument to a fixed object so that the mount body is not movablerelative to the fixed object; adjusting an orientation of an arm thatextends from a distal end of the mount body; and rotating an actuatorrotatably mounted to a proximal end of the mount body, thereby fixingthe orientation of the arm with respect to the mount body in a rigidconfiguration.

According to an example embodiment, a tensioning cable extends throughat least portions of the proximal half of arm and the mount body andconnects with the actuator, and the rotation of the actuator increasestension in the cable.

According to an example embodiment, the fixed object is a sternalretractor and the arm contacts an inner surface of the sternal retractorin the rigid configuration.

According to an example embodiment, the instrument is a surgicalstabilizer.

According to an example embodiment, the instrument is a surgicalstabilizer for beating heart surgery, or an organ positioner for beatingheart surgery.

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body, an arm, a joint, and a tool; themount body configured to mount to a retractor, a bottom surface of themount body facing the retractor when mounted, a front edge of the mountbody running at an angle to the bottom surface; the arm pivotallyconnected on a proximal end of the arm via the joint to or along thefront edge of the mount body; the tool connected to a distal end of thearm; the arm configured to be movable between a plurality of positionsrelative to the mount body and to be temporarily lockable in thesepositions; and the joint configured such that a proximal portion of thearm extending from and adjacent the mount body is pivotable to andtemporarily lockable in a position substantially perpendicular to themount body along portions of the front edge.

According to an example embodiment, the surgical instrument furthercomprises a universal connector configured to connect the mount body toany one of a plurality of retractors of different size.

According to an example embodiment, the joint includes a disk member.

According to an example embodiment, the joint includes a slotted ball.

A surgical instrument according to an example embodiment of the presentinvention comprises: an actuator rotatably mounted to the mount body atthe proximal end of the mount body and a cable extending from theactuator through the mount body, disk member, slotted ball and arm, andthe actuator and the cable are configured to change a state of the armfrom a flexible state to a rigid state by rotation of the actuator in afirst rotational direction, and from the rigid state to the flexiblestate by rotation of the actuator in a counter-rotational direction.

According to an example embodiment, a tube is provided in fluidcommunication with the tool.

According to an example embodiment, a tube is provided in fluidcommunication with the tool, and the actuator includes a clip configuredto receive and temporarily hold the tube to maintain the tube in a lowprofile arrangement with the instrument.

According to an example embodiment, the mount body includes a recesssized to receive and removably retain the tube.

According to an example embodiment, the instrument is a stabilizer andthe tool comprises at least one contact member configured to be exertedagainst a tissue surface to stabilize the tissue surface.

According to an example embodiment, the instrument is a positioner andthe tool comprises a suction member defining a vacuum space therein,wherein the suction member is configured to exert sufficient suctionforce on an organ to move the organ when the suction member is placedagainst the organ, a negative pressure is applied within the vacuumspace to engage the suction member with the organ, and the suctionmember is moved.

According to an example embodiment, the instrument includes a cableextending through the disk member, at least a portion of the arm and atleast a portion of the mount body, wherein the disk member comprises aslot formed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, an actuator is rotatably mounted tothe mount body at the proximal end of the mount body and a cable extendsfrom the actuator through the mount body, disk member, slotted ball andarm.

According to an example embodiment, the actuator and the cable areconfigured to change a state of the arm from a flexible state to a rigidstate by rotation of the actuator in a first rotational direction, andfrom the rigid state to the flexible state by rotation of the actuatorin a counter-rotational direction.

According to an example embodiment, a canister is provided in fluidcommunication with the tube, the canister having an opening forconnecting the canister in fluid communication with a vacuum source, thecanister configured to trap fluid therein.

According to an example embodiment, a filter is in fluid communicationwith the opening of the canister, and the filter is configured to beconnected to the vacuum source and to filter particulates from effluentfrom the canister.

According to an example embodiment, a strap is connected to the canisterand adapted to hang the canister in an upright orientation wherein theopening for connecting the canister with a vacuum source is higher thana connection forming the fluid communication of the canister with thevacuum tube.

According to an example embodiment, a surgical instrument is providedthat includes a mount body, an arm, a tool, and a tube; the mount bodyconfigured to mount to a retractor or a surgical table; the armpivotally connected on a proximal end to the mount body; the toolconnected to a distal end of the arm; the arm configured to be movablebetween a plurality of positions relative to the mount body and to betemporarily lockable in these positions; a distal end of the tubeconnected at or adjacent a distal end of the arm; and the mount bodyconfigured to removably retain the tube.

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body having a top portion, a distal end, aproximal end and a bottom portion; a plurality of mount body jaws formedby or connected to the bottom portion; a joint member engaged to an arm,the arm extending distally from the joint member and terminating with aworking end mounted to a distal end portion of the arm, the joint memberpivotally mounted at a distal end portion of the mount body; wherein thearm through positioning of the joint member is capable of beingpositioned towards the left or right distal regions of the mount bodywithout interfering with a space located above the mount body jaws andimmediately dorsal to the top portion of the mount body.

According to an example embodiment, the joint member is capable of beingpositioning with constrained movement of at least a portion of the jointmember with respect to a plane horizontally aligned with respect to thetop portion of the mount body.

According to an example embodiment, the working end is configured forattachment to the surface of a heart, the working end further includinga stabilizer member to engage one or both sides of a coronary artery, ora positioner member capable of receiving the apex of the heart.

A surgical instrument according to an example embodiment of the presentinvention comprises: a flexible arm comprising a distal end, a proximalend, and a plurality of joint members located therebetween whereby atleast a portion of adjoining joint members can form articulating joints;a working end configured to engage a surface of a human's heart, whereinthe working end is connected to the distal end of the flexible arm; anda mount body joint forming a mount body angle between the proximal endof the flexible arm and a mount body, a minimum mount body angle beingat most than 120 degrees, wherein a reference angle is defined as 180degrees between any two unstressed articulating joint members.

According to an example embodiment, the minimum mount body angle isgreater than 105 degrees.

According to an example embodiment, the mount body joint is comprised ofa horizontal joint and a vertical joint, wherein the horizontal joint isconfigured for controlled planar translation or pivoting along a firstplane that is substantially horizontal, and the vertical joint isconfigured for generally planar translation or pivoting along a secondplane that is substantially perpendicular to the first plane.

A surgical instrument according to an example embodiment of the presentinvention comprises: a flexible arm comprising a distal end, a proximalend, and a plurality of joint members located therebetween whereby atleast a portion of adjoining joint members can form articulating joints,the articulating joints capable of establishing a plurality of arm jointangles each having a minimum achievable angle value, the angle beingdefined as 180 degrees between any two unstressed articulating joints; aworking end configured to engage a surface of a human's heart, whereinthe working end is connected to the distal end of the flexible arm; anda mount body joint forming a mount body angle between the proximal endof the flexible arm and a mount body, a minimum mount body angle being asubstantially smaller angle than a smallest of the minimum achievableangle values.

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body having a top portion, a distal end, aproximal end and a bottom portion and connected to a joint member; amount body jaw formed by or connected to the bottom portion; the jointmember engaged to a proximal portion of an arm that extends distallyfrom the joint member and terminates with a working end, the jointmember being pivotally mounted at a distal end portion of the mountbody; wherein the joint member prohibits a proximal portion of the armfrom extending above the top portion of the mount body.

A surgical instrument according to an example embodiment of the presentinvention comprises: a mount body having a top surface, a distal end, aproximal end and a bottom portion; a joint member including a diskmember pivotally mounted in a distal end portion of the mount body; anarm extending distally from the disk member; and a working end mountedto a distal end portion of the arm.

According to an example embodiment, the joint member forms a joint witha proximal end of the arm.

According to an example embodiment, the joint member includes a slottedball.

According to an example embodiment, the slotted ball is fixed to thedisk member.

According to an example embodiment, the instrument includes an actuatorrotatably mounted to the mount body at the proximal end of the mountbody and a cable extending from the actuator through the mount body,disk member, slotted ball and arm, and the actuator and the cable areconfigured to change a state of the arm from a flexible state to a rigidstate by rotation of the actuator in a first rotational direction, andfrom the rigid state to the flexible state by rotation of the actuatorin a counter-rotational direction.

According to an example embodiment, the slotted ball forms a joint witha proximal end of the arm.

According to an example embodiment, upper and lower surfaces of the diskmember extend substantially parallel with the top surface of the mountbody, and the ball extends angularly downward from a plane parallel tothe upper and lower surfaces.

According to an example embodiment, a vacuum tube is provided in fluidcommunication with the working end.

According to an example embodiment, an actuator is rotatably mounted tothe mount body at the proximal end of the mount body. The actuator isconfigured to change a state of the arm from a flexible state to a rigidstate by rotation of the actuator in a first rotational direction, andfrom the rigid state to the flexible state by rotation of the actuatorin a counter-rotational direction.

According to an example embodiment, a suction tube is provided in fluidcommunication with the working end, and the actuator includes a clipconfigured to receive and temporarily hold the suction tube to maintainthe suction tube in a low profile with the instrument.

According to an example embodiment, the actuator comprises a pluralityof fins with one of the clips formed in each of the fins.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises at least one contact member configured to beexerted against a tissue surface to stabilize the tissue surface.

According to an example embodiment, the instrument is a positioner andthe working end comprises a suction member defining a vacuum spacetherein, wherein the suction member is configured to exert sufficientsuction force on an organ to move the organ when the suction member isplaced against the organ, a negative pressure is applied within thevacuum space to engage the suction member with the organ, and thesuction member is moved.

According to an example embodiment, the bottom portion comprises amounting mechanism configured to clamp the instrument to a fixed object.

According to an example embodiment, the mounting mechanism is fixed to ablade of a sternal retractor and the arm is oriented downwardly and incontact with an inner surface of the sternal retractor blade.

According to an example embodiment, the mounting mechanism comprises afixed jaw and a movable jaw; and a mounting mechanism actuator ispivotally mounted within the bottom portion above the movable jaw. Themounting mechanism actuator is configured to move the movable jaw froman unlocked position to a locked position and vice versa.

According to an example embodiment, the mounting mechanism actuator isconfigured to move the movable jaw toward the locked position when themounting mechanism actuator is pulled in a proximal direction.

According to an example embodiment, a cam is mounted above a bottomsurface of the movable jaw and below the mounting mechanism actuator.The cam is connected to the mounting mechanism actuator to be actuatedto lock or unlock the movable jaw.

According to an example embodiment, the mounting mechanism comprises amounting mechanism actuator, and the mounting mechanism actuatorincludes rocker switches with cams configured to clamp to the fixedobject on opposite side of the fixed object.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members and a blower/misterdevice incorporated into at least one of the contact members.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members and the stabilizeris configured for a blower/mister device to be attached thereto.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members and supports linkingthe contact members to the arm, wherein the supports are pivotallylinked to the contact members.

According to an example embodiment, the contact members each comprise aclip at a proximal end portion thereof, and the clips are configured toform a snap fit with the support members.

According to an example embodiment, the instrument is a stabilizer andthe working end comprises a pair of contact members. The contact memberseach have a relatively thicker cross-sectional dimension at an outsideedge thereof and a relatively thinnest cross-sectional dimension at aninside edge thereof.

According to an example embodiment, the arm comprises an intermediatelink that is adjustable by user to adjust a portion of the arm distal ofthe intermediate link and the working member to assume a flexibleconfiguration in a first configuration, and to assume a rigidconfiguration in a second configuration, while allowing a portion of thearm proximal of the intermediate link to remain flexible during both thefirst configuration and the second configuration.

According to an example embodiment, the arm comprises an intermediatelink that is adjustable by a user to adjust a portion of the armproximal of the intermediate link to assume a flexible configuration ina first configuration, and to assume a rigid configuration in a secondconfiguration, while allowing a portion of the arm distal of theintermediate link and the working end to remain flexible during both thefirst configuration and the second configuration.

According to an example embodiment, a motor is configured to operate theactuator, and a second actuator is provided. The second actuator islocated distally of the actuator and the motor, and is electricallyconnected to the motor, and configured to actuate the motor to drive theactuator to increase or decrease rigidity in the arm and a connectionbetween the arm and the working end.

According to an example embodiment, the top surface of the mount body issmooth and flat with no obstructions thereon, and the top surfaceprovides a rest for a surgeon's hand, that can be used to help stabilizethe surgeon's hand.

According to an example embodiment, ridges or ratchet teeth are providedaround a least a portion of a perimeter of the disk member.

According to an example embodiment, the instrument includes a cableextending through the disk member, at least a portion of the arm and atleast a portion of the mount body, wherein the disk member comprises aslot formed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, the disk member comprises a slotformed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, an actuator is rotatably mounted tothe mount body at the proximal end of the mount body and a cable extendsfrom the actuator through the mount body, disk member, ball and arm. Theactuator and the cable are configured to change a state of the arm froma flexible state to a rigid state by rotation of the actuator in a firstrotational direction, and from the rigid state to the flexible state byrotation of the actuator in a counter-rotational direction.

According to an example embodiment, the suction/vacuum tube comprises acolor-coded connector at a proximal end thereof, the connectorconfigured to be connected to a source of vacuum or another vacuum linein fluid communication with a source of vacuum.

According to an example embodiment, a canister is provided in fluidcommunication with the suction/vacuum tube, the canister having anopening for connecting the canister in fluid communication with a vacuumsource, the canister configured to trap fluid therein.

According to an example embodiment, a filter is in fluid communicationwith the opening of the canister, and the filter is configured to beconnected to the vacuum source and to filter particulates from effluentfrom the canister.

According to an example embodiment, the canister has at least onesubstantially flat side.

According to an example embodiment, a strap is connected to the canisterand adapted to hang the canister in an upright orientation wherein theopening for connecting the canister with a vacuum source is higher thana connection forming the fluid communication of the canister with thevacuum tube.

According to an example embodiment, a surface of the canister is mattedto inhibit glare reflection therefrom.

In another aspect of the present invention, a method of operating asurgical instrument is provided, including: attaching a mount body ofthe instrument to a fixed object so that the mount body is not movablerelative to the fixed object; adjusting an orientation of an arm thatextends from a distal end of the mount body; and rotating an actuatorrotatably mounted to a proximal end of the mount body, thereby fixingthe orientation of the arm in a rigid configuration.

According to an example embodiment, a tensioning cable extends throughthe arm and the mount body and connects with the actuator, and therotation of the actuator increases tension in the cable.

According to an example embodiment, the fixed object is a sternalretractor and the arm contacts an inner surface of the sternal retractorin the rigid configuration.

According to an example embodiment, the instrument is a surgicalstabilizer.

According to an example embodiment, the instrument is an organpositioner.

In another aspect of the present invention, a surgical system isprovided that includes: a surgical retractor having at least one railadapted to mount surgical instruments thereto; a positioner comprising:a first body having a top surface, a first distal end, a first proximalend and a first bottom portion, wherein the first bottom portioncomprises a first mounting mechanism configured to clamp the positionerto the at least one rail, wherein the first mounting mechanism comprisesa first fixed jaw and a first movable jaw; and wherein a first mountingmechanism actuator is pivotally mounted within the first bottom portionabove the first movable jaw, the first mounting mechanism actuator beingconfigured to move the first movable jaw from an unlocked position to alocked position and vice versa, wherein the first mounting mechanismactuator is configured to move the first movable jaw toward the lockedposition when the first mounting mechanism actuator is pulled in aproximal direction, wherein a first cam is mounted above a bottomsurface of the first movable jaw and below the first mounting mechanismactuator, the first cam connected to the first mounting mechanismactuator to be actuated to lock or unlock the movable jaw, wherein thefirst top surface is smooth and substantially flat with no obstructionsthereon, and wherein the first top surface provides a rest for asurgeon's hand, that can be used to help stabilize the surgeon's hand; afirst joint member including a first disk member pivotally mounted in adistal end portion of the first mount body and a first slotted ballfixed to the first disk member; a first arm extending distally from thefirst joint, wherein the first joint member forms a joint with aproximal end of the first arm; a suction member defining a vacuum spacetherein, wherein the suction member is configured to exert sufficientsuction force on an organ to move the organ when the suction member isplaced against the organ, a negative pressure is applied within thevacuum space to engage the suction member with the organ, and thesuction member is moved; a first actuator rotatably mounted to the firstmount body at the proximal end of the first mount body and a first cableextending from the first actuator through the first mount body, firstdisk member, first slotted ball and first arm, the first actuator andthe first cable being configured to change a state of the first arm froma flexible state to a rigid state by rotation of the first actuator in afirst rotational direction, and from the rigid state to the flexiblestate by rotation of the first actuator in a counter-rotationaldirection, wherein the first disk member comprises a first slot formedtherein, the first slot being curved to facilitate bending andtightening of the cable thereagainst when the first disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of first cable length and first cable tension at different angularpositions of the first disk member relative to the first mount body; anda first vacuum tube in fluid communication with the suction member,wherein the first actuator comprises a clip configured to receive andtemporarily hold the first suction tube to maintain the first suctiontube in a low profile with the positioner; wherein the first actuatorcomprises a plurality of first fins with one of the clips formed in eachof the fins, and wherein the first vacuum tube comprises a firstcolor-coded connector at a proximal end thereof, the first color-codedconnector configured to be connected to a source of vacuum or anothervacuum line in fluid communication with a source of vacuum; a firstcanister in fluid communication with the first vacuum tube via the firstcolor-coded connector, the first canister having a first opening forconnecting the first canister in fluid communication with the firstvacuum source, the first canister configured to trap fluid therein,wherein the first canister has at least one substantially flat side, andwherein a surface of the first canister is matted to inhibit glarereflection therefrom; a first strap connected to the first canister andadapted to hang the first canister in an upright orientation wherein thefirst opening for connecting the first canister with the first vacuumsource is higher than a first connection forming the fluid communicationof the first canister with the first vacuum tube; a first filter influid communication with the first opening of the first canister, thefirst filter configured to be connected to the first vacuum source andto filter particulates from effluent from the first canister; astabilizer comprising: a second body having a top surface, a seconddistal end, a second proximal end and a second bottom portion, whereinthe second bottom portion comprises a second mounting mechanismconfigured to clamp the stabilizer to the at least one rail, wherein thesecond mounting mechanism comprises a second fixed jaw and a secondmovable jaw; and wherein a second mounting mechanism actuator ispivotally mounted within the second bottom portion above the secondmovable jaw, the second mounting mechanism actuator being configured tomove the second movable jaw from an unlocked position to a lockedposition and vice versa, wherein the second mounting mechanism actuatoris configured to move the second movable jaw toward the locked positionwhen the second mounting mechanism actuator is pulled in a proximaldirection, wherein a second cam is mounted above a bottom surface of thesecond movable jaw and below the second mounting mechanism actuator, thesecond cam connected to the second mounting mechanism actuator to beactuated to lock or unlock the movable jaw, wherein the second topsurface is smooth and substantially flat with no obstructions thereon,and wherein the second top surface provides a rest for a surgeon's hand,that can be used to help stabilize the surgeon's hand; a second jointmember including a second disk member pivotally mounted in a distal endportion of the second mount body and a second slotted ball fixed to thesecond disk member; a second arm extending distally from the secondjoint, wherein the second joint member forms a joint with a proximal endof the second arm; a pair of contact members configured to be exertedagainst a tissue surface of the organ to stabilize the tissue surfaceand at least one of the contact members configured to attach ablower/mister device thereto or having a blower/mister deviceincorporated therein; a second actuator rotatably mounted to the secondmount body at the proximal end of the second mount body and a secondcable extending from the second actuator through the second mount body,second disk member, second slotted ball and second arm, the secondactuator and the second cable being configured to change a state of thesecond arm from a flexible state to a rigid state by rotation of thesecond actuator in a second rotational direction, and from the rigidstate to the flexible state by rotation of the second actuator in acounter-rotational direction, wherein the second disk member comprises asecond slot formed therein, the second slot being curved to facilitatebending and tightening of the cable thereagainst when the second diskmember has been pivoted, thereby helping to eliminate or reducevariations in at least one of second cable length and second cabletension at different angular positions of the second disk memberrelative to the second mount body; and a second vacuum tube in fluidcommunication with the suction member, wherein the second actuatorcomprises a clip configured to receive and temporarily hold the secondsuction tube to maintain the second suction tube in a low profile withthe stabilizer; wherein the second actuator comprises a plurality ofsecond fins with one of the clips formed in each of the fins, andwherein the second vacuum tube comprises a second color-coded connectorat a proximal end thereof, the second color-coded connector configuredto be connected to a source of vacuum or another vacuum line in fluidcommunication with a source of vacuum; a second canister in fluidcommunication with the second vacuum tube via the second color-codedconnector, the second canister having a second opening for connectingthe second canister in fluid communication with the second vacuumsource, the second canister configured to trap fluid therein, whereinthe second canister has at least one substantially flat side, andwherein a surface of the second canister is matted to inhibit glarereflection therefrom; a second strap connected to the second canisterand adapted to hang the second canister in an upright orientationwherein the second opening for connecting the second canister with thesecond vacuum source is higher than a second connection forming thefluid communication of the second canister with the second vacuum tube;and a second filter in fluid communication with the second opening ofthe second canister, the second filter configured to be connected to thesecond vacuum source and to filter particulates from effluent from thesecond canister.

In another aspect of the present invention, a surgical instrument isprovided that includes a mount body, an arm, a joint, and a tool; themount body configured to mount to a retractor, a bottom surface of themount body facing the retractor when mounted, a front edge of the mountbody running at an angle to the bottom surface; the arm pivotallyconnected on a proximal end via the joint to the front edge of the mountbody; the tool connected to a distal end of the arm; the arm configuredto be movable between a plurality of positions relative to the mountbody and to be temporarily lockable in these positions; and the jointconfigured such that a proximal portion of the arm extending from andadjacent the mount body is pivotable to and temporarily lockable in aposition substantially perpendicular to the mount body.

According to an example embodiment, the surgical instrument furthercomprises a universal connector configured to connect the mount body toany one of a plurality of retractors of different size.

According to an example embodiment, the joint includes a disk member.

According to an example embodiment, the joint includes a slotted ball.

According to an example embodiment, the instrument includes an actuatorrotatably mounted to the mount body at the proximal end of the mountbody and a cable extending from the actuator through the mount body,disk member, slotted ball and arm, and the actuator and the cable areconfigured to change a state of the arm from a flexible state to a rigidstate by rotation of the actuator in a first rotational direction, andfrom the rigid state to the flexible state by rotation of the actuatorin a counter-rotational direction.

According to an example embodiment, a tube is provided in fluidcommunication with the tool.

According to an example embodiment, a tube is provided in fluidcommunication with the tool, and the actuator includes a clip configuredto receive and temporarily hold the tube to maintain the tube in a lowprofile with the instrument.

According to an example embodiment, the mount body includes a recesssized to receive and removably retain the tube.

According to an example embodiment, the instrument is a stabilizer andthe tool comprises at least one contact member configured to be exertedagainst a tissue surface to stabilize the tissue surface.

According to an example embodiment, the instrument is a positioner andthe tool comprises a suction member defining a vacuum space therein,wherein the suction member is configured to exert sufficient suctionforce on an organ to move the organ when the suction member is placedagainst the organ, a negative pressure is applied within the vacuumspace to engage the suction member with the organ, and the suctionmember is moved.

According to an example embodiment, the instrument includes a cableextending through the disk member, at least a portion of the arm and atleast a portion of the mount body, wherein the disk member comprises aslot formed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, an actuator is rotatably mounted tothe mount body at the proximal end of the mount body and a cable extendsfrom the actuator through the mount body, disk member, ball and arm. Theactuator and the cable are configured to change a state of the arm froma flexible state to a rigid state by rotation of the actuator in a firstrotational direction, and from the rigid state to the flexible state byrotation of the actuator in a counter-rotational direction.

According to an example embodiment, a canister is provided in fluidcommunication with the tube, the canister having an opening forconnecting the canister in fluid communication with a vacuum source, thecanister configured to trap fluid therein.

According to an example embodiment, a filter is in fluid communicationwith the opening of the canister, and the filter is configured to beconnected to the vacuum source and to filter particulates from effluentfrom the canister.

According to an example embodiment, a strap is connected to the canisterand adapted to hang the canister in an upright orientation wherein theopening for connecting the canister with a vacuum source is higher thana connection forming the fluid communication of the canister with thevacuum tube.

In another aspect of the present invention, a surgical instrument isprovided that includes a mount body, an arm, a tool, and a tube; themount body configured to mount to a retractor or a surgical table; thearm pivotally connected on a proximal end to the mount body; the toolconnected to a distal end of the arm; the arm configured to be movablebetween a plurality of positions relative to the mount body and to betemporarily lockable in these positions; a distal end of the tubeconnected at or adjacent a distal end of the arm; and the mount bodyconfigured to removably retain the tube.

According to an example embodiment, the mount body includes a recesssized to receive and removably retain the tube.

According to an example embodiment, the mount body includes a clip sizedto receive and removably retain the tube.

According to an example embodiment, the mount body further includes anactuator rotatably mounted to the surgical instrument, the actuatorbeing configured to change a state of the arm from a flexible state to arigid state by rotation of the actuator in a first rotational direction,and from the rigid state to the flexible state by rotation of theactuator in a counter-rotational direction; and the actuator configuredto removably retain the tube.

According to an example embodiment, the arm is pivotally connected tothe mount body via a joint.

According to an example embodiment, the joint includes a disk member.

According to an example embodiment, the joint includes a slotted ball.

According to an example embodiment, the tube is provided in fluidcommunication with the tool.

According to an example embodiment, that actuator includes a clipconfigured to receive and temporarily hold the tube to maintain the tubein a low profile with the instrument.

According to an example embodiment, the instrument is a stabilizer andthe tool comprises at least one contact member configured to be exertedagainst a tissue surface to stabilize the tissue surface.

According to an example embodiment, the instrument is a positioner andthe tool comprises a suction member defining a vacuum space therein,wherein the suction member is configured to exert sufficient suctionforce on an organ to move the organ when the suction member is placedagainst the organ, a negative pressure is applied within the vacuumspace to engage the suction member with the organ, and the suctionmember is moved.

According to an example embodiment, the instrument includes a cableextending through the disk member, at least a portion of the arm and atleast a portion of the mount body, wherein the disk member comprises aslot formed therein, the slot being curved to facilitate bending andtightening of the cable thereagainst when the disk member has beenpivoted, thereby helping to eliminate or reduce variations in at leastone of cable length and cable tension at different angular positions ofthe disk member relative to the mount body.

According to an example embodiment, an actuator is rotatably mounted tothe mount body at the proximal end of the mount body and a cable extendsfrom the actuator through the mount body, disk member, ball and arm. Theactuator and the cable are configured to change a state of the arm froma flexible state to a rigid state by rotation of the actuator in a firstrotational direction, and from the rigid state to the flexible state byrotation of the actuator in a counter-rotational direction.

According to an example embodiment, a canister is provided in fluidcommunication with the tube, the canister having an opening forconnecting the canister in fluid communication with a vacuum source, thecanister configured to trap fluid therein.

According to an example embodiment, a filter is in fluid communicationwith the opening of the canister, and the filter is configured to beconnected to the vacuum source and to filter particulates from effluentfrom the canister.

According to an example embodiment, a strap is connected to the canisterand adapted to hang the canister in an upright orientation wherein theopening for connecting the canister with a vacuum source is higher thana connection forming the fluid communication of the canister with thetube.

These and other features of the invention will become apparent to thosepersons skilled in the art upon reading the details of the instrumentsand methods as more fully described below.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a surgical instrument configured as a surgicalstabilizer instrument according to an embodiment of the presentinvention.

FIG. 2 illustrates the ability of a joint member, according to thepresent invention, to provide an arm with the ability to be positionedvery close to the inner surface of a sternal retractor, relative to theability of a prior art stabilizer arm.

FIG. 3 is a perspective view of a surgical stabilizer instrumentaccording to an embodiment of the present invention.

FIG. 4 is an exploded view of the stabilizer instrument of FIG. 3.

FIG. 5 is a longitudinal sectional view illustrating a joint member thatincludes a swivel joint that is formed by a disk member pivotallymounted to a mounting mechanism according to an embodiment of thepresent invention.

FIG. 6 illustrates pivoting action provided by the swivel jointillustrated in FIG. 5.

FIG. 7 illustrates a disk member that is slotted through a proximalportion thereof, according to an embodiment of the present invention.

FIG. 8 is a top view of a slot in a partial, longitudinal sectional viewtaken in a plane at right angles to the plane along which the partialsectional view of FIG. 5 is taken.

FIG. 9 illustrates an alternative embodiment of a joint member accordingto the present invention, in which a ball is rotationally mounted to adisk member.

FIG. 10 shows an alternative embodiment to the ball shown in FIG. 9,according to the present invention.

FIG. 11 shows a configuration in which actuator (not shown) is actuatedto drive the mount body against the disk to thereby lock the angularposition of disk relative to body, according to an embodiment of thepresent invention.

FIG. 12 is a sectional view of the embodiment of FIG. 11, but whichadditionally shows the actuator.

FIG. 13A illustrates a side view of an arrangement wherein scallopeddetents are provided in which a ball can nest, according to anembodiment of the present invention.

FIG. 13B illustrates a top sectional view taken along line A-A of FIG.13A.

FIG. 14 illustrates a joint member and mounting mechanism in which anotch or slot is provided in mount body and a ball (or alternativelydisk member) is provided with a feature (lip, tang or finger) thatslides in a notch or groove as the disk member pivots relative to themount body, according to an embodiment of the present invention.

FIG. 15 illustrates a ball having a tri-slot configuration according toan embodiment of the present invention.

FIGS. 16A-16C illustrate a joint member in which a ball is provided witha slot and is rotationally mounted to the distal end of a mount body,according to an embodiment of the present invention.

FIG. 17 shows a device in which both the arm and the actuator areangularly movable relative to the mounting mechanism according to anembodiment of the present invention.

FIG. 18 illustrates an arrangement in which a slotted ball has beenintegrated into a mount body according to an embodiment of the presentinvention.

FIG. 19 illustrates a joint member similar to the embodiment of FIGS.16A-16C, but where the ball is provided with an opening such as athrough bore that defines a pathway through the ball according to anembodiment of the present invention.

FIG. 20A illustrates a surgical instrument configured as a stabilizerinstrument in which pivoting of the arm and working end relative to afixed portion of the mounting mechanism is provided by a turretrotationally mounted on top of the mounting mechanism according to anembodiment of the present invention.

FIG. 20B is a partial longitudinal sectional view of the device of FIG.20A.

FIG. 20C illustrates that the actuator lever can be actuated at manydifferent angles to tighten the cable.

FIG. 21 illustrates a joint member that uses a turret, but where theturret is formed with a disk member and ball according to an embodimentof the present invention.

FIG. 22 shows a surgical instrument configured as an organ positionerinstrument according to an embodiment of the present invention.

FIG. 23 is an exploded view of the instrument of FIG. 22.

FIG. 24 shows two surgical instruments, a first configured as apositioner instrument and a second configured as a stabilizerinstrument, both mounted to rails of a sternal retractor according to anembodiment of the present invention.

FIG. 25 is a partial, longitudinal sectional view of the device of FIG.22.

FIG. 26 is a top view of a slot in a partial, longitudinal sectionalview taken in a plane at right angles to the plane along which thepartial sectional view of FIG. 25 is taken.

FIG. 27 is partial view illustrating details of a mounting mechanismaccording to an embodiment of the present invention.

FIG. 28A shows an actuator drawn back proximally in the locked positionand streamlined with the mounting mechanism according to an embodimentof the present invention.

FIG. 28B illustrates the actuator of FIG. 28A in the unlockedconfiguration according to an embodiment of the present invention.

FIG. 28C is a cross-sectional view of FIG. 28A taken along line 28C-28C.

FIG. 28D is a cross-sectional view of FIG. 28B taken along line 28D-28D.

FIGS. 29A-29B show a side view and an end view, respectively, of anactuator according to an embodiment of the present invention.

FIG. 29C illustrates a surgical instrument configured as a stabilizerinstrument with a mount body configured to removably retain a tube,according to an embodiment of the present invention.

FIGS. 30A-30B show a side view and an end view, respectively, of anactuator according to another embodiment of the present invention.

FIG. 31A is a perspective view of a canister according to an embodimentof the present invention.

FIG. 31B is a longitudinal sectional view of the canister of FIG. 31Ataken along line 31B-31B.

FIG. 31C is a longitudinal sectional view of the canister of FIG. 31Ataken along line 31C-31C.

FIG. 31D illustrates a strap provided with a canister according to anembodiment of the present invention.

FIG. 32 illustrates use of a stabilizer instrument and a positionerinstrument, each with a canister according to an embodiment of thepresent invention.

FIGS. 33A-33B show an alternative mounting mechanism actuator accordingto an embodiment of the present invention.

FIGS. 34A-34B illustrate alternative features that may be provided witha working end of a stabilizer instrument according to variousembodiments of the present invention.

FIG. 35 illustrates a modification whereby contact members are taperedfrom a thicker dimension at the outside edges thereof, to a thinnestdimension at the inside edges 16′ thereof according to an embodiment ofthe present invention.

FIG. 36 illustrates an embodiment of a device having an alternative armin which an intermediate link is provided that is adjustable by a userto adjust the tension in the cable distally thereof according to anembodiment of the present invention.

FIG. 37 illustrates an embodiment of a device having an alternativeactuation mechanism according to an embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Before the present instruments and methods are described, it is to beunderstood that this invention is not limited to particular embodimentsdescribed, as such may, of course, vary. It is also to be understoodthat the terminology used herein is for the purpose of describingparticular embodiments only, and is not intended to be limiting, sincethe scope of the present invention will be limited only by the appendedclaims.

Where a range of values is provided, it is understood that eachintervening value, to the tenth of the unit of the lower limit unlessthe context clearly dictates otherwise, between the upper and lowerlimits of that range is also specifically disclosed. Each smaller rangebetween any stated value or intervening value in a stated range and anyother stated or intervening value in that stated range is encompassedwithin the invention. The upper and lower limits of these smaller rangesmay independently be included or excluded in the range, and each rangewhere either, neither or both limits are included in the smaller rangesis also encompassed within the invention, subject to any specificallyexcluded limit in the stated range. Where the stated range includes oneor both of the limits, ranges excluding either or both of those includedlimits are also included in the invention.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although any methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of the present invention, the preferred methodsand materials are now described. All publications mentioned herein areincorporated herein by reference to disclose and describe the methodsand/or materials in connection with which the publications are cited.

It must be noted that as used herein and in the appended claims, theterms “lock” or “locked” shall mean to constrain or make immovable, ormovable with difficulty.

It must be noted that as used herein and in the appended claims, thesingular forms “a”, “an”, and “the” include plural referents unless thecontext clearly dictates otherwise. Thus, for example, reference to “acontact member” includes a plurality of such contact members andreference to “the device” includes reference to one or more devices andequivalents thereof known to those skilled in the art, and so forth.

The publications discussed herein are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such publication by virtue of prior invention.Further, the dates of publication provided may be different from theactual publication dates which may need to be independently confirmed.

Although the instruments described herein are described for use on theheart, it is noted that these instruments are not limited to use on theheart, but can be used for surgical procedures on other organs ortissues, such as to position and/or stabilize other organs or tissues.

FIG. 1 shows a surgical instrument configured as a stabilizer instrument10 according to an embodiment of the present invention. Stabilizerinstrument 10 includes a mounting mechanism 20 configured to mount thestabilizer instrument 10 to a relatively fixed object, such as a sternalretractor, operating table, etc. In FIG. 1, stabilizer instrument 10 ismounted to a rail 202 of a sternal retractor 200. The sternal retractoris shown being used in an open-chest procedure in which an opening 2 hasbeen spread to expose the heart 4 of the patient 1.

Stabilizer instrument 10 further includes an arm 12 pivotally connectedto and extending distally from a distal end 24 of mount body 22. The topsurface 26 of mount body 22 has a low profile and preferably is smoothso as not to catch sutures, surgical gloves or any other objectsusceptible to being caught on a non-smooth surface. Additionally, thissmooth surface can be used by the surgeon to rest a hand or fingeragainst, to assist in steadying the hand during suturing, for example.Because arm 10 extends from the distal end 24 of mount body 22 and notfrom the top surface 26 as in many prior art instruments, it provides alower profile, relative to the height of the patient's 1 chest 2 and thesternal retractor 200. This makes the instrument less of an obstruction(relative to prior art stabilizer instruments where the arm is attachedto the top of the attachment mechanism) to the surgeon or anyone elsetrying to access the surgical working space 3.

Stabilizer instrument 10 further includes a working end 14 mounted to adistal end portion of arm 12. The working end 14 of stabilizerinstrument 10 includes at least one contact member 16. A pair of contactmembers 16 are provided in the embodiment shown in FIG. 1. Contactmembers 16 are configured and dimensioned to contact the surface oftissue at a surgical target area to stabilize the tissue and tofacilitate the performance of a surgical procedure. For example, in FIG.1, the contact members are shaped, configured and dimensioned to contactthe surface of the heart 4 on opposite sides of a coronary artery onwhich an anastomosis is to be performed.

Contact members 16 may be configured to engage tissue by mechanicalmeans (which optionally may include friction enhancing contactsurfaces), by application of suction, or combinations thereof. There aremany different embodiments of contact members that may be employed in asurgical stabilizer instrument according to embodiments of the presentinvention. Further examples of such contact members and details of thesame can be found in U.S. Pat. Nos. 5,727,569; 5,875,782; 5,894,842;5,906,607; 5,957,835; 5,976,069; 6,032,672; 6,036,641; 6,050,266;6,120,436; 6,213,941; 6,231,506; 6,283,912; 6,290,644; 6,315,717;6,331,158; 6,346,077; 6,375,611; 6,394,951; 6,406,424; 6,511,416;6,626,830; 6,652,454; 6,656,113; 6,673,013; 6,685,632; 6,701,930;6,743,169; 6,758,808; 6,849,044; 6,852,075; 6,893,391; 7,056,287;7,220,228; 7,238,155; 7,326,177; 7,335,158; 7,485,090; 7,497,824; and7,503,891, each of which is hereby incorporated herein, in its entirety,by reference thereto.

Mount body 22 is configured and dimensioned so that the distal end 24thereof is substantially laterally flush with an inner surface 200 i ofthe sternal retractor 200, particularly with an inner surface of thearm/blade 204 of the sternal retractor. Alternatively, the distal end 24may extend slightly beyond the inner surface 200 i or end slightlyproximally of the inner surface 200 i. In any case, when the stabilizerinstrument is fixed to rail 202 as shown in FIG. 1, the distal end 24 ofthe mount body 20 does not extend substantially into the surgicalworking space 3, and thus forms much less of an obstruction thancurrently available surgical stabilizers. Further, the joint member 30that joins arm 12 provides the arm 12 with the ability to be positionedvery close to the inner surface 200 i, relative to the ability of aprior art stabilizer arm 1012 of prior art stabilizer 1000, as shown inFIG. 2. This also reduces the amount of obstruction created by thestabilizer 10 and particularly the stabilizer arm 12. Joint member 30even permits arm 12 to be oriented in contact with the inner surface 200i. Still further, the joint member 20 is configured such that a portionof the arm 12 extending from and immediately adjacent the joint member30 is pivotable to and temporarily lockable in a position substantiallyperpendicular to the mount body 22, as illustrated in FIG. 2.Specifically, as shown in FIG. 2, the most proximal link 44 of arm 12can be positioned substantially perpendicular (i.e., at an angle ofabout 80 degrees to about 90 degrees) to the mount body 22.

Joint member 30 is pivotally mounted to mount body 22 at the distal endportion thereof, so that arm 12, which is joined to the distal end ofjoint member 30, extends from the distal end 24 of mount body 22. FIG. 3is a perspective view of a surgical stabilizer instrument 10 accordingto an embodiment of the present invention. Working end 14 is mounted tothe distal end of arm 12 via a joint 56 (ball and socket joint in theembodiment shown in FIG. 3) as described in more detail in previouspatents incorporated by reference above.

Arm 12 comprises a plurality of articulating links 40 that allow the arm12 to be flexible in a first configuration, but which can be compressedto render the arm 12 substantially rigid in a second configuration. Inthe embodiment shown in FIG. 3, links 40 include alternating ball joints42 and biconcave disks 44. Balls 42 are made of a plastic have ahardness that is less than the hardness of the material (typically,plastic) that the disks 44 are made of. This allows the disks 44 tobecome embedded into the balls 42 during compression of the componentsapplied by applying tension to the tensioning member runningtherethrough, thus increasing the rigidity of the arm by the gripimposed by the embedding disks. Further details and examples of suitablearms are described in U.S. Pat. No. 6,506,149, which is herebyincorporated herein, in its entirety, by reference thereto.Alternatively, links 40 may include (but alternatives are not limited tothese examples) a series of ball joints, a series of joints having oneconvex side and one concave side, or any of the other embodimentsdescribed in U.S. Pat. No. 6, 506, 149, or any of the embodimentsdescribed in U.S. Pat. No. 6,758,808, for example.

Each link 40 includes a central channel 40 c therethrough which may betapered at both ends to allow a cable 46 (see the exploded view of FIG.4) to pass through it smoothly and easily (and to improve rigidity inthe arm's rigid state). Cable 46 extends through links 40, joint member30, mount body 22 and connects proximally to an actuation mechanism 50and connects distally to a mechanism configured to lock or unlock joint56. The distal-most articulating member 43 at the distal end of arm 12includes a cavity 43 c which opens at the distal end of the articulatingmember 43 and is adapted to at least partially receive coupling members58, 47 and 60. A socket member 56 s caps the distal end of thestabilizer arm 12 and is mated to the distal most articulating member 43via coupling members 58, 47 and 60, in concert with the tensioning cable46 which runs through the stabilizer.

Socket member 56 s includes an opening 56 p, which is dimensioned tofreely receive the ball portion 56 b to which working end 14 is fixed.Socket member 56 s further includes a slot 56 l dimensioned to receivestem 56 t, allowing it to slide freely in the slot 56 l while at thesame time preventing ball portion 56 b from passing therethrough. Aproximal opening is provided in the socket member 56 s and dimensionedto receive at least a portion of coupling members 58, 47 and 60.

Coupling member 60 may be a socket cap which is received within theproximal opening. Socket cap 60 includes a base or cap portion (shownand described in greater detail in U.S. Pat. No. 6,758,808) to abut ballportion 56 b and maintain it in its position in the socket member 56 s.In the example shown, the cap portion has a substantially planar bottomsurface with a circular opening dimensioned to ride against thesphericity of the ball portion 56 b. Of course, other configurations ofthe bottom surface are contemplated which would accomplish the samefunction, e.g., the ability to apply force against the ball portion 56 band maintain the ball portion within the socket member 56 s, while alsoallowing the ball portion to rotate. Still further, upon increasedapplication of force, the cap portion has the ability to lock the ballportion 56 s and prevent it from rotating.

The outer surface of the socket cap 60 is substantially cylindrical andadapted to slidably and rotatably fit within the cavity of the couplingmember 56 s introduced by the proximal opening thereof. This allowsrotation of the working end 14 about the longitudinal axis of themaneuverable arm 12 when the stabilizer 10 is in a non-rigid state. Theproximal portion of the socket cap 60 includes driving surfaces adaptedto abut against the distal most articulating member 43 and transmitforce against the ball portion 56 b when the cable is tensioned. Uponcomplete release of tension in the stabilizer 10 cable 46, the socketmember 56 s may be pulled in a direction away from the distal mostarticulating member 43 by a sufficient distance to allow ball portion 56b to be extracted through opening 56 p, for example to change the setupby replacing the existing working end 14 with a different one. Thus, achange may be made between working ends 14 to choose a different designor configuration, or even to change to one which operates on a differentprinciple. For example a change from a mechanical contact member, whichoperates by applying physical pressure against the beating heart tissue,may be replaced with a negative pressure contact member, which engagesthe heart by vacuum. In this regard, any of the contact membersdescribed herein could be exchanged for operation in the stabilizer 10described. Additionally, other known contact members could be used oradapted to be used by those of ordinary skill in the art.

The socket cap 60 further includes recessed or open portions dimensionedto receive the arms of coupling member 58. The recessed portions arecontinuous over the length of the socket cap 60 and are also definedalong the perimeter of the cap portion. In this way, the arms ofcoupling member 58 interfit with the socket cap and are continuous withthe outer perimeter thereof to form a cylindrical surface for rotatingagainst the socket member 56 s. The interior surface of socket member 56s is undercut near the proximal end to form an annular groove thatextends around the interior circumference of the proximal end portionand underlies a lip formed thereby. Upon assembly, tines which extendoutwardly from the arms of coupling member 58 at the distal ends of thearms, engage the groove and are prevented from being withdrawn from thesocket member 56 s by the lip. Because the lip and groove extend aroundthe entire inner circumference of the socket member 56 s, couplingmember 58 is free to rotate with socket cap 60 in an unlockedconfiguration of the stabilizer 10. The outside ends of the tines arepreferably chamfered or beveled to ease the insertion of the couplingmember 58 into the socket member 56 s.

A cable fitting is provided as a part of the coupling assembly, andincludes an enlarged ball-shaped or other shape stop portion/couplingmember 47 which has an abutment surface adapted to abut against couplingmember 58 to apply a force thereto when the cable is drawn upthereagainst.

The proximal end of cable 46 is connected to actuation mechanism that isconfigured to increase or decrease tension in cable 46 by drawing theproximal end portion of cable 46 proximally or moving it distallyrelative to mount body 22, respectively. Increase and decrease oftension is actuated by actuator 52, such as the knob shown in FIGS. 3-4.Further details about the operation of mechanism 50 and alternativeembodiments of such mechanism can be found, for example, in U.S. Pat.No. 6,758,808 and other patents incorporated by reference above. Thepresent invention is not intended to be limited to the mechanism 50shown in FIG. 4, as other mechanisms that provide the same function canbe substituted.

In the embodiment shown in FIGS. 3-4, working end 14 includes openings16 s through the contact surfaces of contact members 16 that areconfigured to apply suction (negative pressure) to the surface of thetissue to be stabilized, to cause the contact surfaces to engage thetissue. Openings 16 s are in fluid communication with vacuum tube 62,which is configured, at its proximal end, to be connected in fluidcommunication with a source of negative pressure. A connector 64provided at the proximal end of vacuum tube 62 may be color coded (e.g.,color coded blue, or some other distinct color), so that users canreadily visually distinguish this vacuum tube from other vacuum tubesthat may be being used during the procedure (such as a vacuum tube for apositioner, discussed in more detail below). This can be important whenthe different vacuum tubes require different vacuum characteristics,such as the magnitude of negative pressure, for example, as it helpsprevent mistaken attachment of a vacuum tube to the wrong vacuum source.Color coding the luer or tubing is an inexpensive way of distinguishingthe tube.

The joint member 30 includes a swivel joint 32 that is formed by a diskmember 34 pivotally mounted to mounting mechanism 20 as illustrated inFIG. 3 and in the partial, longitudinal sectional view of FIG. 5. Thepivoting action provided by swivel joint 32 allows the stabilizer arm 12to be pivoted out of the way so that the arm does not excessivelyprotrude into the surgical working space 3. As illustrated in FIG. 6,the arm can be pivoted towards the right or left of the distal end 24 ofmount body 22, by pivoting disk member 34 relative to mount body 22, sothat the arm 12 approximates or even contacts the inner surface of theretractor 200 i and the arm can thus be adjusted to follow along thecontour of the perimeter of the surgical working space 3. The pivotingcan be achieved along a single plane coexistent with the disk member 34.Additionally, the pivoting can occur without movement of the actuatingmechanism 50 with respect to the mount body 22.

Disk member 34 is slotted with slot 34 s through a proximal portionthereof, forming top and bottom proximal disk surfaces 34 p wherein theslot 34 s typically sweeps through at least about 120 degrees of theperiphery of the disk member 34, more typically at least about 150degrees as shown in FIG. 7, and extends into the center of the diskmember 34. Slot 34 s allows the cable 46 to be tensioned whilemaintaining (i.e., without changing or affecting) the rotationalposition of disk member 34 relative to the mount body 22. The pivotpoint at the center of the disk member 34 allows the disk member 34 tomaintain its angular position during tensioning of the cable 46.

As shown in the embodiment of FIG. 8, which provides a top view of slot34 s in a partial, longitudinal sectional view taken in a plane at rightangles to the plane along which the partial sectional view of FIG. 5 istaken, the disk member 34 rotates in a circular slot without a pin.Pivoting is caused by sliding along mating circular surfaces of the diskmember 34 and the circular slot. The disk member 34 is held in place byfriction and an interference fit with the circular slot 22 s formedwithin the distal end 24 of mount body 22. The radius of the disk member34 is slightly larger than the radius of curvature of slot 22 s. Whenthe cable 46 is tensioned, the disk member 34 is pulled into a seatformed by the circular slot 22 s. Chamfers 34 r formed by removingcorners at the top and bottom circular edges of the disk member 34 (seeFIG. 5) may be provided to facilitate seating the disk member 34. Whenthe cable 46 is not tensioned, the disk member 34 is retained in thedistal end of the mount body by arm 12, distal end of mount body 24 andcable 46. The curvature 34 c at the distal ends of the slot facilitatesbending and tightening of the cable thereagainst when disk member 34 hasbeen pivoted, and helps to eliminate or reduce variations in cablelength/tension at different angular positions of the disk member 34.Preferably the disk member is metal such as stainless steel, and theball 36 is plastic and press fitted onto disk member 34. Ball member 36,like the other balls in the arm, is softer than the disc member 44 thatit interfaces with, so that disc member 44 bites into ball 36 to helpprovide further rigidify to the arm 12 when the arm 12 is in a lockedconfiguration.

Additionally, joint member 30 includes a ball 36 extending from a distalend of disk member 34 as shown in FIG. 7. Ball 36 is dimensioned tocooperate with a concave proximal surface of link 44, thereby allowingball and socket type, three-dimensional articulation of the link (andtherefore the arm 12 and working end 14) relative to ball 36. Ball 36may also be slotted 36 s to further facilitate or optionally control thedownward angulation of arm 12 relative to mount body 22, therebyfacilitating positioning the arm downwardly and following the contour ofthe retractor and perimeter of the surgical opening as illustrated inFIG. 6. Slot 36 s may be provided with a curvature 36 c on the proximalend thereof, as illustrated in FIG. 5. Curvature 36 c at the proximalend of the slot 36 s facilitates bending and tightening of the cablethereagainst when arm 12 has been pivoted downwardly relative to ball36/disk member 34, and helps to eliminate or reduce variations in cablelength/tension at different angular positions of the arm 12. Further, alubricious sleeve 46 s (such as one made of polytetrafluoroethylene) orlubricious coating nay be provided over cable 46 to help facilitatesliding and reduce friction, as illustrated in FIG. 8.

FIG. 9 illustrates an alternative embodiment of joint member 30 in whichball 36 is rotationally mounted to disk member 34. Optionally, detentsor ratchet teeth 48 may be provided to allow a ratchet-like adjustmentof the rotational position of ball 36, relative to disk member 34.

FIG. 10 illustrates another alternative embodiment of ball 36 whereinball 36 is provided with two intersecting slots 36 s 1, 36 s 2 formedperpendicularly to one another. Further alternatively, three or moreintersecting slots 36 s may be provided. Like the previous embodiments,ball 36 may be fixed to disk member 34 or may be rotationally mounted todisk member 34. Optionally, detents or ratchet teeth 48 may be providedto allow a ratchet-like adjustment of the rotational position of ball36, relative to disk member 34.

FIG. 11 shows an embodiment in which actuator (not shown) is actuated todrive disk 34 against mount body 22 to thereby lock the angular positionof disk 34 relative to body 22. Additionally, ball 36 is angleddownwardly relative to the plane of orientation of disk 34, i.e., seeangle 39. It is noted that any of the other balls 36 described above aswell as below can alternatively be positioned at a downwardly angledorientation relative to the plane of disk 34.

FIG. 12 is a sectional view of the embodiment of FIG. 11, but whichadditionally shows an actuator 52. As the actuator 52 is tightened (byturning against the screw mechanism within) against the body 22 itdrives the disk 34 against body 22 and at the same time, pulls the balls36, 42 and links/disc members 44 together, tightening the arm 12 andjoint between disk 34 and housing 22.

FIGS. 13A-13B illustrate a side view and a top sectional view takenalong line A-A of FIG. 13A, wherein mount body 22 is provided at itsdistal end portion with a plurality of horizontally and radiallydistributed scallops or detents 54 each configured and dimensioned toreceive a proximal most ball 42 of arm 12 or 1012. Upon applying tensionthrough cable 46, this draws the proximal-most ball 42 into lockingengagement with the receptacle/scallop/detent 54 in which it ispositioned. Further application of tension locks the arm 12, 1012 asalready described. Upon removing tension from cable 46 and sufficientlylengthening/loosening the cable 46, the proximal most ball 42 can bemanually dislodged from it current position in one of the scallops 54and moved to a desired location received by another of the scallops 54,as indicated in phantom lines in FIG. 13B. Thus, proximal most ball 42can be positioned (and then locked) in any of the scallops, therebyproviding the ability to angle the arm 12, 1012 in the horizontal planerelative to the longitudinal axis of the mount body 22, as illustratedby angle 57 in FIG. 13B.

FIG. 14 illustrates an embodiment of joint member 30 and mountingmechanism 20 in which a notch or slot 66 is provided in mount body andball 36 (or alternatively disk member 24) is provided with a feature(lip, tang or finger) 68 that slides in notch or groove 66 as diskmember 34 pivots relative to mount body 22. Upon locking down the jointmember 30, arm 12 and working member 14 by drawing on cable 46 usingactuator 52, feature 68 abuts against the upper surface of slot 66,which prevents the disk member 34 from lifting. Pin 35 is shown in FIG.14 and is the feature about which disk member pivots. A spring 70 isprovided in slot 70 s. Spring 70 has sufficient spring force to separatethe proximal end of disk member 34 from contact with the mount body 22when tension is release in cable 46.

FIG. 15 illustrates an embodiment of ball 36 having a tri-slotconfiguration in which slots 36 a 1, 36 s 2 and 36 s 3 join to form aY-shape.

FIGS. 16A-16B illustrate an embodiment of a joint member 30 in which aball 36 is provided with a slot 36 s and is rotationally mounted to thedistal end of mount body 22. In this way, joint member 30 providessimilar functionality to the joint members 30 previously described thatinclude disk member 34 and ball 36. The functionality is similar in thatball 36 can be rotated (see curved arrows in FIG. 16B), which thenallows horizontal rotation or pivoting of the arm 12 when slot 36 s ishorizontally oriented as in FIG. 16C.

FIG. 17 shows an embodiment in which both the arm 12 and the actuator 52are angularly movable relative to the mounting mechanisms 20. In thisregard, a joint 72 is provided to allow at least downward angulation ofthe actuator knob 52 relative to the mounting mechanism 20. Any of thejoint members 30 described herein may be provided to allow angulation ofthe arm 12 relative to the mounting mechanism. By allowing angularmovement of the actuator, this allows the user to move the actuator 52to cause less of an obstruction to the surgeon or other personnel tryingto access the surgical space 3. It is also less likely to catch suturesor other equipment when moved downwardly as shown in FIG. 17.

FIG. 18 illustrates an embodiment in which slotted ball 36 has beenintegrated into mount body 22. This reduces part count required formanufacturing, but may not be as efficient at maintaining the relativepivotal position of the arm 12 relative to the mount body 22 when thecable 46 is tightened. Optionally scallops 74 may be provided in theslotted portion 36 s of ball 36 to reduce the tendency of the cable 46to straighten the arm 12 relative to the body 22 as tension is applied.

FIG. 19 illustrates an embodiment of a joint member 30 similar to theembodiment of FIGS. 16A-16C, but where ball 36 is provided with anopening 36 p such as a through bore that defines a pathway through ball36 that guides cable 46 from an orientation substantially aligned withthe longitudinal axis of body 22 at end 36 p 1, to an orientationforming an angle with respect to the longitudinal axis of the body 22 atend 36 p 2. In the example shown, the angle is about ninety degrees.However this angle may vary and may be selected from a range of aboutseventy-five degrees to about one hundred thirty five degrees, moretypically from a range of about eighty degrees to about one hundred andten degrees. A cross pin 37, such as a stainless steel pin may beprovided to help support the guide path of 36 p and to help reduce wear.Pin 37 provides the location over which the cable bends. The pin 37 isprovided as a metal component to withstand the high drag (frictional)forces when the cable 46 is pulled at high tensions over the bend 36 p.Pin 37 is cross-pinned through component 36, such a by press fittingand/or using adhesives or other fixative. Ball 36 is further providedwith slot 36 s and is rotationally mounted to the distal end of mountbody 22. In this way, joint member 30 provides similar functionality tothe joint members 30 previously described that include disk member 34and ball 36. The functionality is similar in that ball 36 can berotated, which then allows change in the angular position of arm 12relative to the horizontal plane. Also, a rigid insert molded curvedtube can be provided around the cable to prevent or reduce wear of thecomponents as the tube provides less frictional resistance than thecable as it slides against the other components.

FIG. 20A illustrates an embodiment of a stabilizer instrument in whichpivoting of the arm 12 and working end relative to a fixed portion ofmounting mechanism 20 is provided by a turret 30 t rotationally mountedon top of the mounting mechanism 20. Actuator 52′ in this embodimentcomprise a lever that is configured with a cam mechanism for quicktensioning (and also quick release of tension) of cable 46. The contactmembers 16 of working portion 14 are supported intermediate of theirlengths by shafts 17 used to support the contact members 16 and connectthem to arm 12 via shaft 17′ and a ball joint mechanism like describedpreviously. The intermediate connection of the shafts 17 to the contactmembers 16 places stabilization points closer to the target surgicalsite to be stabilized.

FIG. 20B is a partial longitudinal sectional view of the device 10 ofFIG. 20A showing the path of cable 46 through the mounting mechanism 20and turret 30 t. Because the cable extends up through the center 30 c ofthe turret 30 t, this allows the turret to maintain its rotationalposition relative to mount mechanism 20 during tightening. FIG. 20Cillustrates that actuator lever 52′ can be actuated at many differentangles to tighten the cable 46.

FIG. 21 illustrates a joint member that uses a turret 30 t, but wherethe turret 30 t is formed with a disk member 34 and ball 36. Disk member34 is slotted 34 s and ball 36 is slotted 36 s. Turret 30 t interfacesthe distal end of mount body 22, and is provided with detents 34 d fordiscrete incremental rotations of the turret 30 t relative to mount body22 and which help to maintain the current angular position of turret 30t relative to mount body 22. A pivot element 34 p such as a peg or thelike is inserted into slot 28 s of fixation mount 28 which allows turret30 t to rotate relative to fixation mount 28 and mount body 22, and alsoallows cable 46 to draw turret 30 t into contact with the distal surface24 of mount body 22 and compress it thereagainst to prevent rotation ofturret 30 t relative to mount body 22.

FIG. 22 shows a surgical instrument configured as an organ positionerinstrument 100 according to an embodiment of the present invention.Positioner instrument 100 includes a mounting mechanism 120 configuredto mount the positioner instrument 100 to a relatively fixed object,such as a sternal retractor, operating table, etc. In FIG. 24,positioner instrument 100 is mounted to a rail 202 of a sternalretractor 200.

Positioner instrument 100 further includes an arm 112 pivotallyconnected to and extending distally from a distal end 124 of mount body122. The top surface 126 of mount body 122 is smooth so as not to catchsutures, surgical gloves or any other object susceptible to being caughton a non-smooth surface. Additionally, this smooth surface can be usedby the surgeon to rest a hand or finger against, to assist in steadyingthe hand during suturing or other procedural step, for example. Becausearm 112 extends from the distal end 124 of mount body 122 and not fromthe top surface 126, it provides a lower profile, relative to the heightof the patient's 1 chest opening 2 and the sternal retractor 200 than adesign where the arm extends from a top of the mount body. This makesthe instrument less of an obstruction (relative to prior art stabilizerinstruments where the arm is attached to the top of the attachmentmechanism) to the surgeon or anyone else trying to access the surgicalworking space 3.

Positioner instrument 100 further includes a working end 114 mounted toa distal end portion of arm 112. The working end 114 of positionerinstrument 100 includes at least one contact member 116. A singlecontact member 116 is provided in the embodiment shown in FIG. 22,although multiple contact members 116 may be alternatively provided. Acompliant joint 118 is provided for mounting contact member 116 to arigid structure while still allowing a limited range of movements of thecontact member 116. Contact member 116 is a suction member that isconfigured to attach to an organ and engage the organ by application ofnegative pressure through the suction member, with sufficient strengthto move the engaged organ and maintain it in a displaced orientation. Inone embodiment, this includes maintaining the apex of the heart in anelevated, suspended, orientation. Suction member 116 of FIGS. 22-23includes a cup 151, a hollow shaft 153 fixedly attached to cup 151, andfitting 157 (for attaching a suction line 162 to shaft 153). Shaft 153is oriented with its axis parallel to the central longitudinal axis ofcup 151. Conforming seal 252 is mounted to the distal surface of cup151. Seal 252 forms a seal with the heart (or other organ) when vacuumis applied through cup 151 and seal 252 is placed in contact with theorgan. Optionally a filter 155, such as a foam filter, screen or thelike, can be fitted within the cup 151 (by friction fit, co-moldingand/or adhesive or other mechanical or chemical means, for example) toprevent the organ tissue from being sucked substantially into theinternal area of cup 151. The concave inner surface of cup 151 mayfurther optionally be lined with soft and absorbent material (preferablynon-woven rayon or viscose fabric, but alternatively another materialsuch as gauze or a material of a type currently used in neuro-sponges).The absorbent material is preferably capable of absorbing enough bloodand/or other bodily fluid to significantly improve traction between thecup and organ, and preferably also functions (together with filter 155,if present) to diffuse the suction exerted by member 151 on the organ.

Conforming seal 252 is preferably made of biocompatible foam having someopen cells (to control a slow flow of air through seal 252), and somehas closed cells (including those which define a “skin” on the distalsurface of seal 252, which is the surface designed to contact theorgan). The size and ratio of the open cells to the closed cells governsthe rate at which air moves through the seal 252, in order to hold andcontinue to hold suction (with the skin of the seal 252 engaged againstan organ or tissue) with a given amount of vacuum applied in 151. Asnoted, the skin is especially smooth so that when contacting the surfaceof the organ/tissue, it forms a seal therewith that is airtight and doesnot leak to reduce the amount of vacuum applied.

Compliant joint 118 is attached to the distal end of arm 112. Thisconnection may be formed in the same manner as described above withregard to components 43, 47, 58, 60 and 56 s above in the stabilizerembodiment of FIGS. 3-4. Alternative connections may be substituted asdescribed in the patents that have been incorporated above. Otheralternative connections, as well as alternative suction members that maybe substituted can be found in U.S. Pat. Nos. 6,019,722; 6,338,712;6,361,493; 6,390,976; 6,506,149; 6,610,008; 6,730,020; 6,969,349;6,705,988; 6,726,622; 6,743,170; 6,899,670; 7,179,224; 7,195,591;7,226,409; 7,377,895; 7,404,792; 7,476,196; 7,476,199; and 7,479,104,each of which is hereby incorporated herein, in its entirety, byreference thereto.

Arm 112 may be made in the same manner as arm 12 discussed above,although the members 140 and 142 may have smaller cross sectionaldimensions than corresponding members 40 and 42. Alternatively, any armthat has a flexible configuration, and which can be actuated to a rigidconfiguration may be used, including any arms described in any of thepatents incorporated by reference herein. Mounting mechanism 120 isprovided to fix the positioner 100 to a stationary object, such as asternal retractor or other fixed object.

Fork 165 is fixed to ball 56 b via a post or is integrally made with theball 56 b and post. Ball 56 b is free to rotate relative to socket 56 swhen the cable 46 is relieved of tension and arm 112 is in a flexiblestate. This freedom to rotate is three-dimensional freedom provided by aball and socket arrangement. Roller 164 is rotationally mounted betweenthe tines of form 165 and is free to rotate relative thereto. Roller 164defines a central channel 164 c, and shaft 153 of contact member 114extends through channel 164 c as shown in FIG. 22. Preferably, spring156 is positioned around shaft 153 between fitting 157 and roller 164.Spring 156 is compressed by the force exerted on it by fitting 157 androller 164.

During beating heart surgery, the positioner 100 of FIG. 22 functions asfollows. Working portion 114 is fixedly attached by suction exertedthrough suction line 162, fitting 157, shaft 153 and cup 151 to thesurface of the beating heart, thereby engaging the working portion 114so that the cup 151 moves as a unit with the beating heart. The weightof the heart causes shaft 153 (and the entire cup 151) and roller 164 torotate as a unit relative to fork 165. As shaft 153 and roller 164rotate as described relative to fork 165, fork 165 typically alsorotates relative to socket 56 s. In some implementations, the device isimplemented so that rotation of fork 165 relative to socket 56 s occursonly during gross manipulation of the suction member 151 (with the heartcoupled by suction to the suction member). In addition, as the shaft 153and cup 151 oscillate, substantially vertically as a unit with thesurface of the beating heart, shaft 153 slides (through central channel164 c of roller 164) relative to roller 164 (as the vertical position ofroller 164 is fixed by fork 165.

Spring 156 dampens the oscillating motion of shaft 153 relative toroller 164, in the following manner. As shaft 153 slides verticallydownward relative to roller 164, spring 156 is compressed (convertingsome of the kinetic energy of shaft 153 into potential energy). Then, asshaft 153 slides vertically upward relative to roller 164, spring 156relaxes (elongates) back to its equilibrium position (assisting inpulling the heart surface upward as some of the potential energy storedin the spring is converted to kinetic energy of shaft 153). Optionally,fork 165 may include a pivoting latch (not shown, see U.S. Pat. No.6,506,149, FIG. 30 and description thereof) which can be manuallyrotated between two positions: a first position in which it does notprevent shaft 153 from translating relative to roller 164; and a second(locking) position in which it prevents translation of shaft 153relative to roller 164.

Mount body 122 is configured and dimensioned so that the distal end 124thereof is substantially flush with an inner surface 200 i of thesternal retractor 200, particularly with an inner surface of thearm/blade 204 of the sternal retractor. Alternatively, the distal end124 may extend slightly beyond/inward of the inner surface 200 i or endslightly before/outward of the inner surface 200 i. In any case, whenthe positioner instrument 100 is fixed to rail 202 as shown in FIG. 24,the distal end 124 of the mount body 20 does not extend substantiallyinto the surgical working space 3, and thus forms much less of anobstruction than currently available surgical stabilizers. Further, thejoint member 130 that joins arm 112 provides the arm 112 with theability to be positioned very close to the inner surface 200 i. Thus,both the stabilizer instrument 10 and the positioner instrument 100 asdescribed herein, can be oriented so that the arms 12 and 112,respectively, thereof, follow along the perimeter of the working space,thereby greatly increasing the amount of unobstructed working space 3available to the surgeon, as shown in FIG. 24. Joint member 130 evenpermits arm 112 to be oriented in contact with the inner surface 200 i.In particular, the mount body angles of positioning are possible due tothe pivoting of joint member 130 (or of ball 36 with slot 36 s). Theseangles created by pivoting joint member 130 are substantially smallerthan the angles created by alternating ball joints 142.”

Joint member 130 is pivotally mounted to mount body 122 at the distalend portion thereof, so that arm 112, which is joined to the distal endof joint member 130, extends from the distal end 124 of mount body 122.Arm 112 comprises a plurality of articulating links 140 that allow thearm 112 to be flexible in a first configuration, but which can becompressed to render the arm 112 substantially rigid in a secondconfiguration. In the embodiment shown in FIGS. 22-23, links 140 includealternating ball joints 142 and biconcave disks 144, as described inmore detail in U.S. Pat. No. 6,506,149. Alternatively, links 140 mayinclude (but alternatives are not limited to these examples) a series ofball joints, a series of joints having one convex side and one concaveside, or any of the other embodiments described in U.S. Pat. No.6,506,149, or any of the embodiments described in U.S. Pat. No.6,758,808, for example.

Each link 140 includes a central channel therethrough which may betapered at both ends to allow a cable 46 (see the exploded view of FIG.23) to pass through it smoothly and easily (and to improve rigidity inthe arm's rigid state). Cable 46 extends through links 140, joint member130, mount body 122 and connects proximally to an actuation mechanism 50and connects distally to a mechanism configured to lock or unlock joint56. The distal-most articulating member 43 at the distal end of arm 112includes a cavity which opens to the distal end of the articulatingmember 43 and is adapted to at least partially receive coupling members58, 47 and 60. A socket member 56 s caps the distal end of thepositioner arm 112 and is mated to the distal most articulating member43 via coupling members 58, 47 and 60, in concert with the tensioningcable 46 which runs through the positioner.

The proximal end of cable 46 is connected to an actuation mechanism thatis configured to increase or decrease tension in cable 46 by drawing theproximal end portion of cable 46 proximally or moving it distallyrelative to mount body 122, respectively. Increase and decrease oftension is actuated by actuator 152, such as the knob shown in FIGS.22-23. Further details about the operation of mechanism 50 andalternative embodiments of such mechanism can be found, for example, inU.S. Pat. No. 6,758,808 and other patents incorporated by referenceabove. The present invention is not intended to be limited to themechanism 50 shown in FIG. 23, as other mechanisms that provide the samefunction can be substituted.

In the embodiment shown in FIGS. 22-23, working end 114 includes asuction cup 151 that is configured to apply suction (negative pressure)to the surface of the tissue to be positioned or manipulated, to causethe cup 151 to engage the tissue. Suction cup 151 is in fluidcommunication with vacuum tube 162, which is configured, at its proximalend, to be connected in fluid communication with a source of negativepressure. A connector 164 provided at the proximal end of vacuum tube162 may be color coded (e.g., color coded yellow, or some other distinctcolor), so that users can readily visually distinguish this vacuum tube162 from vacuum tube 62 or other vacuum tubes that may be being usedduring the procedure. This is important to distinguish, since themagnitude of negative pressure used for the positioner 100 may differsignificantly from the magnitude of negative pressure applied throughthe stabilizer 10.

The joint member 130 includes a swivel or pivot joint 132 that is formedby a disk member 134 pivotally mounted to mounting mechanism 120 asillustrated in FIG. 22 and in the partial, longitudinal sectional viewof FIG. 25. The pivoting action provided by swivel joint 132 allows thestabilizer arm 112 to be pivoted out of the way so that the arm does notprotrude into the surgical working space 3. As illustrated in FIG. 25,the arm 112 can be pivoted, by pivoting disk member 134 relative tomount body 122, so that the arm 112 approximates or even contacts theinner surface of the retractor 200 i and the arm 112 can thus beadjusted to follow along the contour of the perimeter of the surgicalworking space 3.

Disk member 134 is slotted 134 s through a proximal portion thereof,wherein the slot 134 s typically sweeps through at least about 120degrees of the periphery of the disk member 134, more typically at leastabout 150 degrees as shown in FIG. 26, and extends into the center ofthe disk member 134. Slot 134 s allows the cable 46 to be tensionedwhile maintaining the swivel position of disk member 134 relative to themount body 122.

FIG. 26 provides a top view of slot 134 s in a partial, longitudinalsectional view taken in a plane at right angles to the plane along whichthe partial sectional view of FIG. 25 is taken. The curvature 34 c atthe distal ends of the slot facilitates bending and tightening of thecable 46 thereagainst when disk member 134 has been pivoted, and helpsto eliminate or reduce variations in cable length/tension at differentangular positions of the disk member 134.

Additionally, joint member 130 includes a ball 136 extending from adistal end of disk member 134 as shown in FIGS. 25-26. Ball 136 isdimensioned to cooperate with a concave proximal surface of link 144,thereby allowing ball and socket type, three-dimensional articulation ofthe link (and therefore the arm 112 and working end 114) relative toball 136. Ball 136 may also be slotted 136 s to further facilitate thedownward angulation of arm 112 relative to mount body 122, therebyfacilitating positioning the arm downwardly and following the contour ofthe retractor and perimeter of the surgical opening as illustrated inFIG. 24. Slot 136 s may be provided with a curvature on the proximal endthereof. The curvature at the proximal end of the slot 136 s facilitatesbending and tightening of the cable thereagainst when arm 112 has beenpivoted downwardly relative to ball 136/disk member 134, and helps toeliminate or reduce variations in cable length/tension at differentangular positions of the arm 112. Further, a lubricious sleeve 46 s(such as one made of polytetrafluoroethylene) or lubricious coating naybe provided over cable 46 to help facilitate sliding and reducefriction.

Other variations of ball 136 may be provided, including, but not limitedto the variations of ball 36 described above Likewise, alternativeembodiments of disk member 134 may be provided like the alternativeembodiments of disk member 34 described above.

FIG. 27 is partial view illustrating details of a mounting mechanism 20according to an embodiment of the present invention. Although thesedetails are described with regard to mounting mechanism 20 for astabilizer instrument 10 (shown for example in FIGS. 3-4), it is notedthat the details apply equally to a mounting mechanism 120 for apositioner instrument according to an embodiment of the presentinvention (shown for example in FIGS. 22-23), as the same mechanism canbe used.

Unlike conventional locking mechanisms that use a lever and a cam toadvance a movable jaw of a clamping mechanism relative to a fixed jaw inorder to fix the mechanism to a fixed object, wherein the lever isco-planar with the bottom surface of the movable jaw or the bottomsurface of the lever is below the top surface of the movable jaw,mounting mechanism actuator (e.g., lever or the like) 80 of theembodiment of the present invention shown in FIG. 27 is slidably mountedin mount body 22 (or 122) so that the entirety of the mounting mechanismactuator 80 is positioned above the upper surface 82 u of movable jaw 82and the working mechanism is embedded in the housing and jaw. Thisarrangement elevates the actuator 80 above the skin of the patient whenthe mounting mechanism 20 is being fixed to a sternal retractor forexample, thereby greatly reducing the chances of pinching the skin ofthe patient in the actuator mechanism as the actuator 80 is actuated,whether to fix the mechanism to the retractor or remove it therefrom.Also, the camming mechanism is concealed within the movable jaw 82, sothat it does not risk catching or grabbing the patient's tissue duringuse. Also, the mechanism is designed to allow for a lower profile formounting, relative to current devices, and therefore the stabilizer orpositioner is less obstructive to the surgical field and adjacent areasused by the surgeon. Some components of the mounting mechanism 20 areformed of metal to further reduce the profile of the mounting mechanism.For example, the lever 80 a portion of the actuator, cam 81 (FIGS. 28C)and, optionally, the lever grip portion 80 b of the actuator are made ofmetal to provide a more compact configuration of the mounting mechanismcompared to prior art designs that make one or more of these componentsfrom polymer.

Additionally, unlike conventional mounting mechanisms wherein theactuator lever is rotated distally to fix the mechanism to a retractor,the actuator 80 of the present invention is drawn proximally (i.e.,towards the user) to fix or lock the mounting mechanism 20 (or 120) to aretractor. Ergonomically, this makes it easier for the user to lock aninstrument 100 or 10 to a sternal retractor, as the proximal rotation iseasier to perform and can generally be done with one hand, where itoften takes both hands to fix a mechanism that requires distal rotationof the lever to fix the mechanism, since it is easy to hold the body 22and pull, using one hand, but difficult to hold the body and push, usingthe same hand. Also, in the conventional mechanisms, the lever extendsoutwardly from the mounting mechanism and extends alongside the rail ofthe retractor when the mechanism is fixed thereto, thereby preventinganother instrument from being mounted close to that mechanism. In thepresent invention, however, actuator 80 is drawn back proximally in thelocked position and streamlined with the mounting mechanism 20,120, seeFIG. 28A. This allows placement of another instrument much closer to themounting mechanism 20, 120 on the rail of the retractor, relative towhat is permitted by currently available mechanisms.

FIG. 28B illustrates the actuator 80 in the unlocked configuration,which allows initial placement of the mounting mechanism on the fixedobject, such as a sternal retractor, or removal of the mountingmechanism from the fixed object. FIG. 28C is a cross-sectional view ofFIG. 28A taken along line 28C-28C, and showing mounting mechanism 20,120in the locked configuration. Movable jaw 82 is biased toward fixed jaw84 by biasing member 88, such as a coil spring, or other biasing member.Accordingly, when mounting mechanism 20, 120 is placed over the rail202, the rail 202 is contacted on opposite sides by jaws 84, 82, asbiased to this position by biasing member 88. By drawing actuator 80proximally, a cam 81 linked to actuator 80 is rotated and draws aninternal jaw component 82 a in movable jaw 82 upwardly to engageinternal jaw component teeth 82 c against upper teeth 84 c, therebylocking the movable jaw 82 relative to the fixed jaw 84 and locking themounting mechanism 20, 120 in a position clamped against the rail 202.Thus mechanism 20,120 holds the instrument 10, 1000 securely to the rail202, assisting in the prevention of movement of the arm or surgicalinstrument.

FIG. 28D is a cross-sectional view of FIG. 28B taken along line 28D-28D,and showing mounting mechanism 20,120 in the unlocked configuration andwith movable jaw retraced so that the mounting mechanism 20, 120 can beremoved from the rail 202 (or to facilitate placing the mountingmechanism 20, 120 over the rail before clamping and locking it). Bypushing actuator 80 distally, the cam 81 counter-rotates, therebyremoving teeth 82 c fro contact with teeth 84 c and allowing movable jaw82 to move away from fixed jaw 84, as well as rail 202, and providingenough clearance between both jaws 82, 84 relative to rail 202 to allowthe mounting mechanism 20, 120 to be lifted off of the rail 202. Thepushing motion of the actuator 80 requires less effort by the user tounlock and remove the instrument from the surgical site. Further detailsabout the operation of the cam relative to the movable jaw can be foundin U.S. Pat. No. 6,685,632. A spring 88 is provided that biases movablejaw 82 towards fixed jaw 84. To first place the jaws 82, 84 over therail 202, the user draws back on jaw 82 while holding the fixed portionof the mechanism 20, 120 (jaw 84 or other fixed portion) to spread thejaws apart. Once the jaws have cleared the top rail flanges, the jaw 82can be released, and spring 88 moves jaw 82 towards jaws 84 to bring thejaws into lateral contact with the rail 202.

FIGS. 29A-29B show a side view and an end view, respectively, of anactuator 52. Actuator 52 is provided with a clip 52 c provided in atleast one of the fins 52 f thereof. In the embodiment shown, a clip 52 cis formed in each of the fins 52 f. Alternatively, only one or two ofthe fins 52 f could be provided with clips 52 c. Each clip 52 c isconfigured to receive and temporarily or reversibly hold suction tube 62to help maintain the suction tube in a low profile as it follows alongthe profile of the instrument 10/arm 12, e.g., see FIG. 3. The opening52 o of the clip 52 c has a distance across that is slightly less thanthe outside diameter of the tube 62. Accordingly, the tube 62 has to bepinched or deformed in order to insert it through the opening 52 o ofthe clip 52 c.

Alternatively, or in addition to temporarily holding tube 62 in clip 52c, tube may be temporarily held in recess 22 c provided in mount body22, as shown in FIG. 29C. Recess 22 c is configured to receive andtemporarily hold suction tube 62 to help maintain the suction tube in alow profile as it follows along the profile of the instrument 10/arm 12,e.g., see FIG. 29C. The opening of the recess 22 c has a distance acrossthat is slightly less than the outside diameter of the tube 62.Accordingly, the tube 62 has to be pinched or deformed in order toinsert it through the opening of the recess 22 c so that it is retainedin recess 22 c once inserted there, until a force is applied to pull itback out of the recess 22 c.

Preferably, tube 62 is a soft, flexible, reinforced tube. However, theinterior 52 b of the main body of the clip 52 c has an inside diameteronly slightly smaller than the outside diameter of the tube 62, so asgrip the tube 62 while keeping constriction relatively insubstantial.Accordingly, the tube 62 is held in position in space 52 b by the softgrip and opening 52 o of clip 52 c prevents the tubing 62 from escapingthe clip during use of the instrument, as operator intervention isrequired to remove the tube again so that it can be repositioned in theopening 52 o.

FIGS. 30A-30B show a side view and an end view, respectively, ofactuator 152. Actuator 152 is provided with a clip 152 c provided in atleast one of the fins 152 f thereof. In the embodiment shown, a clip 152c is formed in each of the fins 152 f. Alternatively, a fewer number oronly one of the fins 152 f could be provided with clip 152 c. Each clip152 c is configured to receive and temporarily hold suction tube 162 tohelp maintain the suction tube 162 in a low profile as it follows alongthe profile of the instrument 100/arm 112, e.g., see FIG. 22. Theopening 152 o of the clip 152 c has a distance across that is slightlyless than the outside diameter of the tube 162. Accordingly, the tube162 has to be pinched or deformed in order to insert it through theopening 152 o of the clip 152 c. However, the interior 152 b of the mainbody of the clip 152 c has an inside diameter slightly smaller than theoutside diameter of the tube 162, so as grip the tube 162, while notoverly constricting the tube 162. Accordingly, the tube 162 is held inposition in space 152 b by the soft grip and opening 152 o of clip 152 cprevents the tubing 162 from escaping the clip during use of theinstrument, as operator intervention is required to remove the tube sothat it can be repositioned in the opening 152 o.

Alternatively, or in addition to temporarily holding tube 62 in clip 152c, tube may be temporarily held in a recess provided in mount body 122.The recess in mount body 122 can be configured in the same way as recess22 c shown in FIG. 29C and described above, and is configured to receiveand temporarily hold suction tube 62 to help maintain the suction tubein a low profile as it follows along the profile of the instrument100/arm 112. It is further noted that mount body 122 may be constructedto be the same as mount body 22.

FIG. 31A is a perspective view of a canister 300 that is configured tobe placed in line, in fluid communication with vacuum line 62 or 162, inbetween device 10 or 100 and the vacuum source. As vacuum is appliedfrom vacuum source 402 or 404 (see FIG. 32), the suction applied to thetissues of the patient 1 not only performs the desired engagement of theworking ends 14,114 with the target tissues, but also tends to drawfluids and particulates up through the vacuum tubes 62, 162. Thesefluids and particulates are drawn in through tubing 302 (see FIG. 31B).A closed-ended cap 304 is provided over the proximal end of tube 302.The inside diameter of cap 304 is significantly larger than the outsidediameter of tube 302 so as to form an annular gap 306 therebetween. Asthe fluids and particulates exit the proximal end of tube 302, theyimpact the closed end of cap 304 or simply (in the case of heaviermaterials) flow over the sides of the tube 302 like a fountain. Ineither case, a majority of the liquids contained in the fluids, as wellas larger, heavier particulates, precipitate out of the fluid flow andare contained by the canister 300 and held at the bottom end portion ofthe canister 300 by gravity, since the canister is oriented verticallyduring use(e.g., see FIG. 32). Also, cap 304 prevents spillage andsplatter of particulates and fluids onto the side walls of the canister300, thereby preventing dirtying of the walls that would otherwiseobstruct the view of the contents and level of the contents. The lighterfluids, such as gases, and potentially some smaller particulatescontinue in the flow, out through tubing 308, see FIG. 31C.

A filter 320 is provided in line, in fluid communication with canister300, between canister 300 and vacuum source 402 or 404, see FIG. 32.Thus, unlike some conventional canisters, filter 320 is not providedinside the canister 300, but is upstream thereof. This prevents filter320 from being saturated by liquids accumulated in the canister, andalso makes it possible to change the filter 320 without having to changethe canister 300, or to change or empty the canister 300 without havingto change the filter 320. Filter 320 is configured to trap particulatesthat were not contained by the canister 300.

Canister 300 is preferably provided with at least one substantially flatside that facilitates mounting of the canister 300 along a wall, forexample. In the embodiment shown in FIGS. 31A-31D, canister 300 has foursubstantially flat sides and is substantially square in cross-section.However, other cross-sectional shapes, including, but not limited totriangular, semi-circular or semi-oval may be substituted. The externalsurface of the canister is also preferably provided with a matted finishso as to minimize glare that might be otherwise reflected from theintense operating room lighting. This not only prevents glare as adistraction, but also facilitates viewing the contents of the canister300, so that it can be monitored to ensure that it does not fill upbefore changing it.

FIG. 31D illustrates a strap 310 that may also be provided with canister300. Strap 310 is attached to canister 300 and is configured to hang thecanister from any stationary projection 330 (see FIG. 32) in theoperating room so as to maintain the canister 300 hanging in the desiredvertical orientation (see FIG. 32), so that outlet 308 is higher thaninlet 302 and canister 300 is oriented substantially vertically.

Turning now to FIGS. 33A-33B, an alternative mounting mechanism actuator80′ is described. Actuator 80′ is shown being used with the instrument10 of FIG. 20A. However, any of the other instruments 10, 100 describedherein could be modified to use this alternative mounting mechanismactuator 80′. Rocker switches 86 with cams 86 c interface with rail 202and apply compressive forces thereagainst, when rotated (see curvedarrows in FIG. 33B), thereby firmly clamping the mount body andinstrument 10,100 to the rail 202.

FIGS. 34A-34B illustrate alternative features that may be provided witha working end 14 of a stabilizer instrument according to variousembodiments of the present invention. The contact members 16 andsupports thereof may be configured to provide a blower/mister device 15integrated into the contact members as shown, so that nozzles oropenings of the blower/mister device are directed inwardly, between thecontact members 16 that they are mounted in, so that they direct misttoward the surgical target located between the contact members 16.Alternatively, the stabilizer instrument may be configured for ablower/mister device to be attached thereto. The working end may beconfigured for a blower/mister device to be attached thereto.

Additionally or alternatively, the supports 17 may be configured topivot relative to contact members 16, as indicated by the arrows in FIG.34A. Contact members 16 may also be provided with clips 19 at theirdistal ends configured to form a snap fit with the support members 17,so as to maintain the working end in a very low profile where bothcontact members and supports extend aligned substantially in the sameplane.

FIG. 35 illustrates a modification whereby contact members 16 aretapered from a thicker dimension at the outside edges thereof, to athinnest dimension at the inside edges 16′ thereof. Other modificationsthat may be performed include, but are not limited to: mounting one ormore cameras on contact members 16 which are linkable to a monitor forviewing, and/or providing an arm 12, 112 that is flexible in a firstconfiguration and, upon application of vacuum thereto, is made rigid ina second configuration.

FIG. 36 illustrates an embodiment of device 10 having an alternative arm12′ in which an intermediate link 45 is provided that is adjustable by auser to adjust the tension in the cable distally thereof. This featurecan accordingly be used to tighten/lock the working end 14 and linksdistal of link 45, while still allowing the links proximal of link 45 toremain flexible. In this way, the user could fix an initial “rough” orcoarse positioning of working end 14 by tightening the distal linksusing link 45 as described, and then fine positioning can be performedby making further fine adjustments to the positioning by manipulatingthe links proximal of link 45. Upon achieving satisfactory fineadjustments to the positioning, the remainder of the links can then belocked down using actuator 52. Further, alternatively, link 45 can beconfigured to tighten the links proximal thereof while allowing linksdistal thereof to remain loose/flexible. In an alternative embodiment, asecond cable alongside cable 46 is provided that connects to link 45distally, passes through the links proximal of link 45 and connects tomount body 22. It is noted that although the modifications describedwith regard to FIG. 36 are shown with regard to a stabilizer instrument10, that any and all of such modifications can also be applied to apositioner instrument 100.

FIG. 37 illustrates an embodiment of device 10 having an alternativeactuation mechanism 52, 52′, 53. In this embodiments actuator 52 can beoperated the same way as described above with regard to FIGS. 3-4.Alternatively, a motor 53 is provided that can be actuated by actuator52′, for example, a push button or other switch electrically connectedthrough arm 12 and mount body 22 to motor 53, to drive actuator 52 toincrease or decrease tension in cable 46. Thus, actuator 52′ allows auser to tighten/lock the working end 14 and arm 12 from the distal endportion of the instrument, for example, while the users hand(s) are inthe vicinity of the distal end portion of the instrument 10 to positionthe working end 14 as desired. It is noted that although themodifications described with regard to FIG. 37 are shown with regard toa stabilizer instrument 10, that the actuator 52′ and motor 53 canlikewise be implemented in a positioner instrument 100 in the samemanner to control actuator 152.

While the present invention has been described with reference to thespecific embodiments thereof, it should be understood by those skilledin the art that various changes may be made and equivalents may besubstituted without departing from the true spirit and scope of theinvention. In addition, many modifications may be made to adapt aparticular situation, material, composition of matter, process, processstep or steps, to the objective, spirit and scope of the presentinvention. All such modifications are intended to be within the scope ofthe claims appended hereto.

1. A surgical instrument comprising: a mount body having a top portion,a distal end, a proximal end and a bottom portion; a joint memberpivotally mounted at a distal end portion of the mount body to allowpositioning of a proximal portion of an arm extending distally from thejoint member, the joint member configured to at least partiallyconstrain movement of the proximal portion of the arm to a plane; and aworking end mounted to a distal end portion of the arm.
 2. Theinstrument of claim 1, wherein the joint member comprises a first jointmember and a second joint member, wherein the first joint memberconfines movement of the proximal portion of the arm to yawing, and thesecond joint member confines movement of the proximal portion of the armto pitching.
 3. The instrument of claim 1, wherein the joint memberpivotally mounted at the distal end portion of the mount body is a diskmember.
 4. The instrument of claim 1, wherein the joint member furthercomprises a slotted ball.
 5. The instrument of claim 4, wherein thejoint member is a disk member, and the slotted ball is connected to thedisk member.
 6. The instrument of claim 4, further comprising anactuator rotatably mounted to the mount body towards the proximal end ofthe mount body, and a cable extending from the actuator through themount body, joint member, slotted ball and arm, the actuator and thecable being configured to change a state of the arm from a flexiblestate to a rigid state by movement of the actuator in a first direction,and from the rigid state to the flexible state by movement of theactuator is a second direction opposite the first direction.
 7. Theinstrument of claim 6, wherein movement of the actuator involvesrotation, the first direction is a first rotational direction, and thesecond direction is a counter-rotational direction.
 8. The instrument ofclaim 4, wherein the slotted ball member forms a joint with a proximalend of the arm.
 9. The instrument of claim 3, wherein upper and lowersurfaces of the disk member extend substantially parallel with the topportion of the mount body, and wherein the slotted ball is capable ofpivoting to an angularly downward position from a plane parallel to theupper and lower surfaces of the disk member.
 10. The instrument of claim1, further comprising a vacuum tube in fluid communication with theworking end, and the working end is configured to reversibly attach tothe exterior surface of a human's heart.
 11. The instrument of claim 1,further comprising an actuator rotatably mounted to the mount body atthe proximal end of the mount body, the actuator being configured tochange a state of the arm from a flexible state to a rigid state byrotation of the actuator in a first rotational direction, and from therigid state to the flexible state by rotation of the actuator in acounter-rotational direction.
 12. The instrument of claim 11, furthercomprising a suction tube in fluid communication with the working end,and a clip configured to receive and temporarily hold the suction tubeto maintain the suction tube in a low profile with the instrument,wherein the clip is formed with or connected to the mount body, theactuator, or both the mount body and the actuator.
 13. (canceled) 14.The instrument of claim 1, wherein the instrument is an organ stabilizerand the working end comprises at least one contact member configured tobe exerted against a tissue surface to stabilize the tissue surface. 15.The instrument of claim 1, wherein the instrument is an organ positionerand the working end comprises a suction member defining a vacuum spacetherein, wherein the suction member is configured to receive the apex ofa human heart.
 16. (canceled)
 17. The instrument of claim 1, wherein thebottom portion comprises a mounting mechanism configured to reversiblyclamp the instrument to a fixed object.
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 28. (canceled)29. The instrument of claim 1, wherein the arm comprises an intermediatelink that is adjustable by a user to adjust a portion of the arm distalof the intermediate link and the working member to assume a flexibleconfiguration in a first configuration, and to assume a rigidconfiguration in a second configuration, while allowing a portion of thearm proximal of the intermediate link to remain flexible during both thefirst configuration and the second configuration.
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 75. A surgical instrumentcomprising: a flexible arm comprising a distal end, a proximal end, anda plurality of joint members located therebetween whereby at least aportion of adjoining joint members can form articulating joints; aworking end configured to engage a surface of a human's heart, whereinthe working end is connected to the distal end of the flexible arm; anda mount body joint forming a mount body angle between the proximal endof the flexible arm and a mount body, a minimum mount body angle beingat most than 120 degrees, wherein a reference angle is defined as 180degrees between any two unstressed articulating joint members.
 76. Thesurgical instrument of claim 75, wherein the minimum mount body angle isgreater than 105 degrees.
 77. The surgical instrument of claim 75,wherein the mount body joint is comprised of a horizontal joint and avertical joint, wherein the horizontal joint is configured forcontrolled planar translation or pivoting along a first plane that issubstantially horizontal, and the vertical joint is configured forgenerally planar translation or pivoting along a second plane that issubstantially perpendicular to the first plane.
 78. A surgicalinstrument comprising: a flexible arm comprising a distal end, aproximal end, and a plurality of joint members located therebetweenwhereby at least a portion of adjoining joint members can formarticulating joints, the articulating joints capable of establishing aplurality of arm joint angles each having a minimum achievable anglevalue, the angle being defined as 180 degrees between any two unstressedarticulating joints; a working end configured to engage a surface of ahuman's heart, wherein the working end is connected to the distal end ofthe flexible arm; and a mount body joint forming a mount body anglebetween the proximal end of the flexible arm and a mount body, a minimummount body angle being a substantially smaller angle than a smallest ofthe minimum achievable angle values.
 79. (canceled)